Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany.
Sci Rep. 2022 Jul 25;12(1):12691. doi: 10.1038/s41598-022-16727-w.
The neutrophil-to-lymphocyte ratio (NLR) is used as biomarker in malignant diseases showing significant association with poor oncological outcomes. The main research question of the present study was whether NLR has also prognostic value in cholangiocarcinoma patients (CCA). A systematic review was carried out to identify studies related to NLR and clinical outcomes in CCA evaluating the literature from 01/2000 to 09/2021. A random-effects model, pooled hazard ratios (HR) and 95% confidence interval (CI) were used to investigate the statistical association between NLR and overall survival (OS) as well as disease-free survival (DFS). Subgroup analyses, evaluation of sensitivity and risk of bias were further carried out. 32 studies comprising 8572 patients were eligible for this systematic review and meta-analysis. The pooled outcomes revealed that high NLR prior to treatment is prognostic for poor OS (HR 1.28, 95% CI 1.18-1.38, p < 0.01) and DFS (HR 1.39, 95% CI 1.17-1.66, p < 0.01) with meaningful HR values. Subgroup analysis revealed that this association is not significantly affected by the treatment modality (surgical vs. non-surgical), NLR cut-off values, age and sample size of the included studies. Given the likelihood of NLR to be prognostic for reduced OS and DFS, pre-treatment NLR might serve as a useful biomarker for poor prognosis in patients with CCA and therefore facilitate clinical management.
中性粒细胞与淋巴细胞比值（NLR）可用作恶性疾病的生物标志物，与不良肿瘤学结局显著相关。本研究的主要研究问题是 NLR 是否对胆管癌（CCA）患者也具有预后价值。进行了系统评价，以确定与 NLR 和 CCA 临床结局相关的研究，评估了 2000 年 1 月至 2021 年 9 月的文献。采用随机效应模型、合并危险比（HR）和 95%置信区间（CI），以调查 NLR 与总生存率（OS）和无病生存率（DFS）之间的统计学关联。进一步进行了亚组分析、敏感性评估和偏倚风险评估。本系统评价和荟萃分析纳入了 32 项研究，共 8572 名患者。汇总结果表明，治疗前 NLR 较高提示 OS（HR 1.28，95%CI 1.18-1.38，p<0.01）和 DFS（HR 1.39，95%CI 1.17-1.66，p<0.01）预后不良，且 HR 值有意义。亚组分析表明，这种相关性不受治疗方式（手术与非手术）、NLR 截断值、年龄和纳入研究的样本量的影响。鉴于 NLR 可能预示 OS 和 DFS 降低，治疗前 NLR 可能是 CCA 患者预后不良的有用生物标志物，从而有助于临床管理。
