Department of Otorhinolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
BMC Cancer. 2018 Apr 4;18(1):383. doi: 10.1186/s12885-018-4230-z.
Recent studies have reported a relationship between prognosis and neutrophil-to-lymphocyte ratio (NLR) in patients with head and neck cancer (HNC). As the results are still controversial, we conducted a meta-analysis of pretreatment NLR in peripheral blood and prognosis in HNC patients.
We retrieved articles from PubMed, Medline, Cochrane Library, Embase and Web of Science. A comparative analysis was conducted for the effect of pretreatment NLR in peripheral blood on overall survival (OS), progression-free survival, disease-free survival (DFS), disease-specific survival, metastasis-free survival, and recurrence-free survival of HNC patients. The analysis applied the criteria for systematic reviews described in the Cochrane Handbook and was conducted using hazard ratios (HRs) to estimate effect size, and calculated by Stata/SE version 13.0.
The meta-analysis included eligible cohort studies (5475 cases). The OS data indicated increased mortality risk in HNC patients with a high NLR (HR = 1.84, 95% confidence interval (CI): 1.53-2.23; P < 0.001; heterogeneity, I = 37.2%, P = 0.074). Analysis of subgroups stratified by NLR cutoff values revealed increased mortality risk and significantly shorter DFS in patients with high NLR compared to those with low NLR (HR = 2.18, 95% CI: 1.46-3.24; P < 0.001). Patients with high NLR had a higher probability of tumor recurrence after treatment than those with low NLR (HR = 1.63, 95% CI: 1.09-2.45; P = 0.017; heterogeneity, I = 68.7%; P = 0.022). The probability of distant metastasis following treatment was greater in patients with high compared with low NLR (HR = 1.92, 95% CI: 1.36-2.72; P < 0.001; heterogeneity, I = 0.0%; P = 0.614). Funnel plots of the meta-analysis results were stable, as shown by sensitivity analysis. No publication bias was detected by the Egger test (P = 0.135).
HNC patients with elevated pretreatment NLR in peripheral blood have poor prognosis and are prone to local invasion and distant metastasis. NLR values are easily obtained from routinely collected blood samples and could assist clinicians to determine prognosis of HNC patients.
最近的研究报告称，头颈部癌症（HNC）患者的中性粒细胞与淋巴细胞比值（NLR）与预后之间存在关系。由于结果仍存在争议，我们对头颈部癌症患者外周血预处理 NLR 与预后进行了荟萃分析。
我们从 PubMed、Medline、Cochrane 图书馆、Embase 和 Web of Science 检索文章。对预处理 NLR 对 HNC 患者的总生存期（OS）、无进展生存期、无病生存期（DFS）、疾病特异性生存期、无转移生存期和无复发生存期的影响进行了对比分析。分析应用了 Cochrane 手册中描述的系统评价标准，并使用风险比（HR）估计效应量，由 Stata/SE 版本 13.0 计算。
荟萃分析纳入了符合条件的队列研究（5475 例）。OS 数据表明，NLR 较高的 HNC 患者死亡风险增加（HR=1.84，95%置信区间（CI）：1.53-2.23；P<0.001；异质性，I=37.2%，P=0.074）。根据 NLR 截断值分层的亚组分析显示，与 NLR 较低的患者相比，NLR 较高的患者死亡风险更高，DFS 显著更短（HR=2.18，95% CI：1.46-3.24；P<0.001）。治疗后 NLR 较高的患者肿瘤复发的可能性高于 NLR 较低的患者（HR=1.63，95% CI：1.09-2.45；P=0.017；异质性，I=68.7%；P=0.022）。治疗后 NLR 较高的患者远处转移的可能性大于 NLR 较低的患者（HR=1.92，95% CI：1.36-2.72；P<0.001；异质性，I=0.0%；P=0.614）。荟萃分析结果的漏斗图显示，敏感性分析稳定。Egger 检验未发现发表偏倚（P=0.135）。
外周血预处理 NLR 升高的头颈部癌症患者预后不良，易发生局部侵袭和远处转移。NLR 值可从常规采集的血液样本中轻松获得，并可帮助临床医生确定头颈部癌症患者的预后。
