Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, People's Republic of China.
Shanxi Medical University, Taiyuan, 030001, Shanxi, People's Republic of China.
World J Surg Oncol. 2020 Oct 23;18(1):273. doi: 10.1186/s12957-020-02048-7.
Growing evidence shows that the preoperative lymphocyte-related systemic inflammatory biomarkers are associated with the prognosis of patients with upper tract urothelial carcinoma (UTUC). These markers include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). However, these findings are inconsistent, and the prognostic significance of these biomarkers is unclear. Moreover, the currently available prognostic indicators do not precisely predict the outcome of UTUC patients. This motivated us to investigate the prognostic values of NLR, PLR, and MLR in UTUC patients treated with radical nephroureterectomy (RNU).
We prospectively registered this in PROSPERO (CRD42020186531). We performed a comprehensive literature search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases to identify the eligible studies evaluating the prognostic values of preoperative NLR, PLR, and MLR. Hazard ratios with 95% confidence intervals of overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival (RFS), metastasis-free survival (MFS), and progression-free survival (PFS) were extracted from the multivariate analyses and analyzed with fixed or random effects models when applicable. Heterogeneity among the studies was evaluated using Cochran's Q test and I statistic. Sensitivity and subgroup analyses were conducted to explore the origin of heterogeneity. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of each enrolled study. Publication bias was determined using funnel plots together with Egger's tests. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of the evidence.
Overall, we included 10,339 UTUC patients from twenty-five retrospective studies. The results indicated that elevated preoperative NLR, PLR, and MLR were significantly associated with worse OS, CSS, DFS/RFS/MFS, and PFS in the UTUC patients undergoing RNU. Furthermore, the results of sensitivity and subgroup analyses demonstrated the rationality and reliability of the results.
The present meta-analysis demonstrated a significant association between elevated preoperative NLR, PLR, and MLR and poor prognosis in patients with surgically treated UTUC. Hence, lymphocyte-related systemic inflammatory biomarkers, in conjunction with clinicopathological factors, molecular markers, and other prognostic indicators, could be helpful to determine the primary treatment strategies and to design individualized follow-up plans for UTUC patients.
越来越多的证据表明，术前淋巴细胞相关的全身炎症生物标志物与上尿路尿路上皮癌（UTUC）患者的预后相关。这些标志物包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和单核细胞与淋巴细胞比值（MLR）。然而，这些发现并不一致，这些生物标志物的预后意义尚不清楚。此外，目前可用的预后指标不能准确预测 UTUC 患者的预后。这促使我们研究 NLR、PLR 和 MLR 在接受根治性肾输尿管切除术（RNU）治疗的 UTUC 患者中的预后价值。
我们在 PROSPERO（CRD42020186531）中前瞻性注册了该研究。我们对 PubMed、Web of Science、EMBASE 和 Cochrane Library 数据库进行了全面的文献检索，以确定评估术前 NLR、PLR 和 MLR 对预后影响的合格研究。使用固定或随机效应模型从多变量分析中提取总体生存（OS）、癌症特异性生存（CSS）、无病生存（DFS）、无复发生存（RFS）、无转移生存（MFS）和无进展生存（PFS）的风险比（HR），并进行分析。使用 Cochran's Q 检验和 I 统计量评估研究之间的异质性。进行敏感性和亚组分析以探讨异质性的来源。应用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。使用漏斗图和 Egger 检验确定发表偏倚。采用推荐评估、制定与评价（GRADE）系统评估证据质量。
总共纳入了 25 项回顾性研究的 10339 例 UTUC 患者。结果表明，在接受 RNU 治疗的 UTUC 患者中，术前 NLR、PLR 和 MLR 升高与 OS、CSS、DFS/RFS/MFS 和 PFS 较差显著相关。此外，敏感性和亚组分析的结果表明了结果的合理性和可靠性。
本荟萃分析表明，术前 NLR、PLR 和 MLR 升高与接受手术治疗的 UTUC 患者预后不良显著相关。因此，淋巴细胞相关的全身炎症生物标志物与临床病理因素、分子标志物和其他预后指标相结合，可能有助于确定 UTUC 患者的主要治疗策略，并制定个体化的随访计划。
