Ethier Josee-Lyne, Desautels Danielle N, Templeton Arnoud J, Oza Amit, Amir Eitan, Lheureux Stephanie
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Canada.
Gynecol Oncol. 2017 Jun;145(3):584-594. doi: 10.1016/j.ygyno.2017.02.026. Epub 2017 Feb 20.
Presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in several malignancies. Here, we quantify the effect of NLR on survival in patients with gynecologic cancers, and examine the effect of clinico-pathologic factors on its prognostic value.
A systematic search of electronic databases was conducted to identify publications exploring the association of pre-treatment blood NLR with overall survival (OS) and event-free survival (EFS) among patients with ovarian, endometrial and cervical cancers. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) or a p-value (P) were weighted by generic inverse-variance and pooled in a random effects meta-analysis. Subgroup analyses were conducted according to primary tumor type. Meta-regression was performed to evaluate the influence of clinico-pathologic factors on the HR for OS and EFS. All statistical tests were two-sided.
Twenty-six studies comprising 10,530 patients were included. Studies used different cut-offs to classify high NLR (range 0.89 to 5.03). The median cut-off for high NLR was 2.95 among twenty-six studies reporting a HR for OS, and 2.79 in seventeen studies reporting EFS outcomes. NLR greater than the cut-off was associated with worse OS (HR 1.65, 95% CI=1.44 to 1.89; P<0.001) and EFS (HR 1.57, 95% CI=1.35 to 1.82; P<0.001). This association was present in all tumor types. Most studies were comprised of patients with both early-stage and advanced disease. In cervical cancer, significant associations between NLR and OS were observed in studies of early- and mixed-stage patients and regression analysis showed a greater magnitude of effect in patients with locally advanced disease and in those who received both chemotherapy and radiation.
High NLR is associated with an adverse OS and EFS in patients with gynecologic malignancies.
高中性粒细胞与淋巴细胞比值（NLR）的存在与多种恶性肿瘤患者死亡率增加有关。在此，我们量化NLR对妇科癌症患者生存的影响，并研究临床病理因素对其预后价值的影响。
对电子数据库进行系统检索，以确定探讨卵巢癌、子宫内膜癌和宫颈癌患者治疗前血液NLR与总生存期（OS）和无事件生存期（EFS）之间关联的出版物。报告风险比（HR）和95%置信区间（CI）或p值（P）的研究数据采用通用逆方差加权，并纳入随机效应荟萃分析。根据原发性肿瘤类型进行亚组分析。进行Meta回归以评估临床病理因素对OS和EFS的HR的影响。所有统计检验均为双侧检验。
纳入了26项研究，共10530例患者。各研究使用不同的临界值来分类高NLR（范围为0.89至5.03）。在报告OS的HR的26项研究中，高NLR的中位临界值为2.95，在报告EFS结果的17项研究中为2.79。高于临界值的NLR与较差的OS（HR 1.65，95%CI = 1.44至1.89；P < 0.001）和EFS（HR 1.57，95%CI = 1.35至1.82；P < 0.001）相关。这种关联在所有肿瘤类型中均存在。大多数研究包括早期和晚期疾病患者。在宫颈癌中，在早期和混合期患者的研究中观察到NLR与OS之间存在显著关联，回归分析显示在局部晚期疾病患者以及接受化疗和放疗的患者中效应幅度更大。
高NLR与妇科恶性肿瘤患者不良的OS和EFS相关。
