Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2020 Sep 30;35(3):262-271. doi: 10.24920/003668.
Objective Accumulated evidence has suggested that there is a close association between preoperative neutrophil-to-lymphocyte ratio (NLR) and prognosis of various malignant tumors. However, the relationship between NLR and surgically resectable urinary cancers remains contradictory. Therefore, we performed this systematic review and meta-analysis to explore whether preoperative NLR could predict the prognosis of surgically resectable urinary cancers. Methods After searching the Embase, PubMed/MEDLINE and Cochrane databases and screening the articles, we finally included 25 studies involving 15950 patients. Hazard ratios (s) and their 95% confidence intervals (s) were extracted to assess the association between preoperative NLR and the overall survival (OS) and cancer-specific survival (CSS) of surgically resectable urinary cancers. Results The pooled results revealed that an elevated preoperative NLR could predict a worse OS (=1.40, 95%: 1.26-1.54, <0.001) and CSS (=1.43, 95%: 1.27-1.59, <0.001) in urinary cancers. In addition, our analyses also suggested that high preoperative NLR was associated with worse prognosis in renal cell carcinoma (OS: =2.06, 95%: 1.54-2.76, =0.131; CSS: =2.46, 95%: 1.46-4.16, =0.178), upper tract urothelial carcinoma (OS: =1.91, 95%: 1.50-2.42, =0.616; CSS: =1.84, 95%: 1.41-2.39, =0.001), bladder cancer (OS: =1.09, 95%: 1.02-1.17, <0.001; CSS: =1.05, 95%: 1.01-1.09, =0.163) and prostate cancer (OS: =1.69, 95%: 1.19-2.41, =0.714). Regardless of the participants' race or the cutoff value of the preoperative NLR, the results remained valid. Conclusion Elevated preoperative NLR could predict a worse prognosis in surgically resectable urinary cancers, namely, renal cell carcinoma, bladder cancer, prostate cancer and upper tract urothelial carcinoma.
大量证据表明，术前中性粒细胞与淋巴细胞比值（NLR）与各种恶性肿瘤的预后密切相关。然而，NLR 与可手术切除的尿路上皮癌之间的关系仍存在争议。因此，我们进行了这项系统评价和荟萃分析，以探讨术前 NLR 是否可预测可手术切除的尿路上皮癌的预后。
我们检索了 Embase、PubMed/MEDLINE 和 Cochrane 数据库，并对文章进行筛选，最终纳入了 25 项研究，共涉及 15950 名患者。提取风险比（HR）及其 95%置信区间（CI），以评估术前 NLR 与可手术切除的尿路上皮癌的总生存率（OS）和癌症特异性生存率（CSS）之间的关系。
汇总结果显示，术前 NLR 升高可预测尿路上皮癌的 OS（HR=1.40，95%CI：1.26-1.54，<0.001）和 CSS（HR=1.43，95%CI：1.27-1.59，<0.001）较差。此外，我们的分析还表明，术前高 NLR 与肾细胞癌（OS：HR=2.06，95%CI：1.54-2.76，=0.131；CSS：HR=2.46，95%CI：1.46-4.16，=0.178）、上尿路上皮癌（OS：HR=1.91，95%CI：1.50-2.42，=0.616；CSS：HR=1.84，95%CI：1.41-2.39，=0.001）、膀胱癌（OS：HR=1.09，95%CI：1.02-1.17，<0.001；CSS：HR=1.05，95%CI：1.01-1.09，=0.163）和前列腺癌（OS：HR=1.69，95%CI：1.19-2.41，=0.714）的预后较差相关。无论参与者的种族或术前 NLR 的截断值如何，结果均有效。
术前 NLR 升高可预测可手术切除的尿路上皮癌（包括肾细胞癌、膀胱癌、前列腺癌和上尿路上皮癌）的预后不良。
