Wang Jin, Zhou Xu, Liu Yu, Li Zheng, Li Xiang
Hematology Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China.
PLoS One. 2017 Apr 25;12(4):e0176008. doi: 10.1371/journal.pone.0176008. eCollection 2017.
Neutrophil-to-lymphocyte ratio (NLR) has been investigated as a prognostic marker in patients with diffuse large B-cell lymphoma (DLBCL); however, the results remain controversial. This study aimed to explore the association between NLR and survival outcomes and clinicopathological factors in DLBCL.
Relevant studies were retrieved by searching PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases. The last search was updated on February 17, 2017. Hazard ratios (HRs) and odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effective measures in the meta-analysis. Random-effects models and fixed-effects models were used for analyses. Meta-regression was performed. Publication bias was assessed using Begg's test. Stata version 12.0 was used for all analyses.
A total of 9 studies with 2297 patients were included in the meta-analysis. The pooled results showed that NLR was a significant indicator for poor overall survival (OS) (HR = 1.84, 95% CI = 1.52-2.22, p<0.001) and poor progression-free survival (PFS) (HR = 1.64, 95% CI = 1.36-1.98, p<0.001). NLR remained a significant biomarker for OS and PFS regardless of location, sample size or cut-off value. In addition, high NLR was also associated with Ann Arbor stage (OR = 2.09, 95% CI = 1.14-3.81, p = 0.017), lactate dehydrogenase level (OR = 2.74, 95% CI = 1.16-6.46, p = 0.021), extranodal disease (OR = 1.63, 95% CI = 1.06-2.52, p = 0.027), and International Prognostic Index score (OR = 2.44, 95% CI = 1.03-5.08, p = 0.043). However, NLR was found to have no significant association with sex (OR = 0.89, 95% CI = 0.71-1.11, p = 0.29), age (OR = 1.18, 95% CI = 0.94-1.48, p = 0.152), European Cooperative Oncology Group performance status score (OR = 1.78, 95% CI = 0.71-4.46, p = 0.217), or presence of B symptoms (OR = 1.56, 95% CI = 0.7-3.48, p = 0.278).
In conclusion, our meta-analysis demonstrated that NLR has a strong association with worse OS and PFS in patients with DLBCL. NLR could be recommended as an inexpensive prognostic biomarker in DLBCL.
中性粒细胞与淋巴细胞比值（NLR）已被作为弥漫性大B细胞淋巴瘤（DLBCL）患者的预后标志物进行研究；然而，结果仍存在争议。本研究旨在探讨NLR与DLBCL患者生存结局及临床病理因素之间的关联。
通过检索PubMed、Embase、Web of Science和中国知网（CNKI）数据库获取相关研究。最后一次检索更新于2017年2月17日。风险比（HRs）、比值比（ORs）及其95%置信区间（CIs）用作荟萃分析中的有效测量指标。采用随机效应模型和固定效应模型进行分析。进行了荟萃回归分析。使用Begg检验评估发表偏倚。所有分析均使用Stata 12.0版本。
荟萃分析共纳入9项研究，涉及2297例患者。汇总结果显示，NLR是总生存期（OS）较差（HR = 1.84，95%CI = 1.52 - 2.22，p < 0.001）和无进展生存期（PFS）较差（HR = 1.64，95%CI = 1.36 - 1.98，p < 0.001）的显著指标。无论地理位置、样本量或临界值如何，NLR仍然是OS和PFS的显著生物标志物。此外，高NLR还与Ann Arbor分期（OR = 2.09，95%CI = 1.14 - 3.81，p = 0.017）、乳酸脱氢酶水平（OR = 2.74，95%CI = 1.16 - 6.46，p = 0.021）、结外病变（OR = 1.63，95%CI = 1.06 - 2.52，p = 0.027）以及国际预后指数评分（OR = 2.44，95%CI = 1.03 - 5.08，p = 0.043）相关。然而，发现NLR与性别（OR = 0.89，95%CI = 0.71 - 1.11，p = 0.29）、年龄（OR = 1.18，95%CI = 0.94 - 1.48，p = 0.152）、欧洲癌症研究与治疗组织体能状态评分（OR = 1.78，95%CI = 0.71 - 4.46，p = 0.217）或B症状的存在（OR = 1.56，95%CI = 0.7 - 3.48，p = 0.278）无显著关联。
总之，我们的荟萃分析表明，NLR与DLBCL患者较差的OS和PFS密切相关。NLR可被推荐作为DLBCL中一种廉价的预后生物标志物。
