Feng Jidong, Wang Yanyan, Shan Guohui, Gao Lei
Department of General Surgery.
Endocrine Metabolic Disease Section, the Affiliated Hospital to Changchun University of Chinese Medicine.
Medicine (Baltimore). 2020 May;99(20):e19686. doi: 10.1097/MD.0000000000019686.
Although the malignant degree is relatively low and overall prognosis is excellent, some patients with thyroid cancer still experience metastasis during the follow-up, which leads to their possible death. Pretreatment neutrophil-to-lymphocyte ratio (NLR) has been recommended as a biomarker for the prediction of metastasis and prognosis in patients with cancers. However, its value in thyroid cancer remains inconclusive. This study aimed to comprehensively evaluate the prognostic and clinicopathological significance of NLR for thyroid cancer by a meta-analysis.
Eligible studies were identified by searching PubMed, EMBASE, and Cochrane Library databases. The associations between NLR level and disease-free survival (DFS) or clinicopathological parameters were estimated by calculating hazard ratio (HR) or effect size with 95% confidence interval (CI).
Nine studies consisting of 3081 patients were enrolled. Results of meta-analysis showed that elevated NLR was not significantly associated with unfavorable DFS overall, but subgroup analysis of multivariate-adjusted studies demonstrated an elevation in pretreatment NLR predicted poor DFS (HR = 3.51, 95%CI = 1.42-8.70). Overall, a high level of NLR was significantly correlated with larger tumor size (standardized mean difference [SMD] = 0.49, 95%CI = 0.33-0.64), and metastasis status (risk ratio [RR] = 1.70, 95%CI = 1.10-2.64). The association with tumor size was still significant in the stratified analyses by country and histology type (Asian: SMD = 0.719, 95%CI = 0.44-0.98; non-Asian: SMD = 0.36, 95%CI = 0.17-0.56; medullary thyroid carcinoma: SMD = 0.57, 95%CI = 0.09-1.05; papillary thyroid carcinoma: SMD = 0.48, 95%CI = 0.31-0.64). The association between NLR and metastasis was only significant for papillary thyroid carcinoma subtype (RR = 1.82, 95%CI = 1.04-3.20).
Pretreatment NLR may serve as an excellent biomarker for prediction of tumor growth, metastasis, and prognosis in patients with thyroid cancer.
尽管甲状腺癌恶性程度相对较低且总体预后良好，但仍有部分患者在随访期间出现转移，甚至可能导致死亡。治疗前中性粒细胞与淋巴细胞比值（NLR）已被推荐作为预测癌症患者转移和预后的生物标志物。然而，其在甲状腺癌中的价值仍尚无定论。本研究旨在通过荟萃分析全面评估NLR对甲状腺癌的预后及临床病理意义。
通过检索PubMed、EMBASE和Cochrane图书馆数据库来确定符合条件的研究。通过计算风险比（HR）或效应量及95%置信区间（CI）来评估NLR水平与无病生存期（DFS）或临床病理参数之间的关联。
纳入了9项研究，共3081例患者。荟萃分析结果显示，总体而言，NLR升高与不良DFS无显著关联，但多变量调整研究的亚组分析表明，治疗前NLR升高预示着较差的DFS（HR = 3.51，95%CI = 1.42 - 8.70）。总体而言，高水平的NLR与更大的肿瘤大小（标准化均值差[SMD] = 0.49，95%CI = 0.33 - 0.64）和转移状态显著相关（风险比[RR] = 1.70，95%CI = 1.10 - 2.64）。按国家和组织学类型进行分层分析时，与肿瘤大小的关联仍然显著（亚洲：SMD = 0.719，95%CI = 0.44 - 0.98；非亚洲：SMD = 0.36，95%CI = 0.17 - 0.56；甲状腺髓样癌：SMD = 0.57，95%CI = 0.09 - 1.05；甲状腺乳头状癌：SMD = 0.48，95%CI = 0.31 - 0.64）。NLR与转移之间仅在甲状腺乳头状癌亚型中显著相关（RR = 1.82，95%CI = 1.04 - 3.20）。
治疗前NLR可能是预测甲状腺癌患者肿瘤生长、转移和预后的良好生物标志物。
