The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis

D. Liu; L.R. Heij; Z. Czigany; E. Dahl; M. den Dulk; S.A. Lang; T.F. Ulmer; U.P. Neumann; J. Bednarsch

doi:10.1038/s41598-022-16727-w

The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis

D. Liu, L.R. Heij, Z. Czigany, E. Dahl, M. den Dulk, S.A. Lang, T.F. Ulmer, U.P. Neumann, J. Bednarsch^*

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

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.

Original language	English
Article number	12691
Number of pages	12
Journal	Scientific Reports
Volume	12
Issue number	1
DOIs	https://doi.org/10.1038/s41598-022-16727-w
Publication status	Published - 25 Jul 2022

Keywords

ELEVATED PREOPERATIVE NEUTROPHIL
INTRAHEPATIC CHOLANGIOCARCINOMA
COLORECTAL-CANCER
PREDICTS SURVIVAL
INFLAMMATION
RESECTION
SCORES
PLATELET
OUTCOMES
IMPACT

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Cite this

@article{e08d2ebd881b4597bc73ae81ba6b9a14,

title = "The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis",

abstract = "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.",

keywords = "ELEVATED PREOPERATIVE NEUTROPHIL, INTRAHEPATIC CHOLANGIOCARCINOMA, COLORECTAL-CANCER, PREDICTS SURVIVAL, INFLAMMATION, RESECTION, SCORES, PLATELET, OUTCOMES, IMPACT",

author = "D. Liu and L.R. Heij and Z. Czigany and E. Dahl and {den Dulk}, M. and S.A. Lang and T.F. Ulmer and U.P. Neumann and J. Bednarsch",

note = "Funding Information: Open Access funding enabled and organized by Projekt DEAL. This research was supported by DFG (German Research Foundation)—Project-ID 403224013—SFB 1382. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = jul,

day = "25",

doi = "10.1038/s41598-022-16727-w",

language = "English",

volume = "12",

journal = "Scientific Reports",

issn = "2045-2322",

publisher = "Nature Publishing Group",

number = "1",

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TY - JOUR

T1 - The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis

AU - Liu, D.

AU - Heij, L.R.

AU - Czigany, Z.

AU - Dahl, E.

AU - den Dulk, M.

AU - Lang, S.A.

AU - Ulmer, T.F.

AU - Neumann, U.P.

AU - Bednarsch, J.

N1 - Funding Information: Open Access funding enabled and organized by Projekt DEAL. This research was supported by DFG (German Research Foundation)—Project-ID 403224013—SFB 1382. Publisher Copyright: © 2022, The Author(s).

PY - 2022/7/25

Y1 - 2022/7/25

N2 - 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.

AB - 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.

KW - ELEVATED PREOPERATIVE NEUTROPHIL

KW - INTRAHEPATIC CHOLANGIOCARCINOMA

KW - COLORECTAL-CANCER

KW - PREDICTS SURVIVAL

KW - INFLAMMATION

KW - RESECTION

KW - SCORES

KW - PLATELET

KW - OUTCOMES

KW - IMPACT

U2 - 10.1038/s41598-022-16727-w

DO - 10.1038/s41598-022-16727-w

M3 - (Systematic) Review article

C2 - 35879385

SN - 2045-2322

VL - 12

JO - Scientific Reports

JF - Scientific Reports

IS - 1

M1 - 12691

ER -