术前中性粒细胞与淋巴细胞比值预测可切除泌尿系肿瘤预后的价值：系统综述和荟萃分析

doi:10.24920/003668

Abstract

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 (HRs) and their 95% confidence intervals (CIs) 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 (HR=1.40, 95%CI: 1.26-1.54, P<0.001) and CSS (HR=1.43, 95%CI: 1.27-1.59, P<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: HR=2.06, 95%CI: 1.54-2.76, P=0.131; CSS: HR=2.46, 95%CI: 1.46-4.16, P=0.178), upper tract urothelial carcinoma (OS: HR=1.91, 95%CI: 1.50-2.42, P=0.616; CSS: HR=1.84, 95%CI: 1.41-2.39, P=0.001), bladder cancer (OS: HR=1.09, 95%CI: 1.02-1.17, P<0.001; CSS: HR=1.05, 95%CI: 1.01-1.09, P=0.163) and prostate cancer (OS: HR=1.69, 95%CI: 1.19-2.41, P=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.

Key words: urinary cancers, neutrophil-to-lymphocyte ratio, inflammatory biomarkers, prognostic factors, meta-analysis

Wang Zhan, Wang Xu, Wang Wenda, Zheng Guoyang, Guo Hao, Zhang Yushi. Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Prognosis of Surgically Resectable Urinary Cancers: Systematic Review and Meta-Analysis[J].Chinese Medical Sciences Journal, 2020, 35(3): 262-271.

Figures/Tables 8

Figure 1.

Table 1

Characteristics of all the studies included in our meta-analysis"

Author	Year	Country	Tumor type	No. of Patients	Age (yrs)	Gender (M:F)	Cut-off value	Follow-up (months)	Outcomes	Analysis type
Son et al.^[9]	2018	Korea	UTUC	1137	69 (61-74)^*	825:312	3.3	39.1 (18.3-63.8)^*	RFS, CSS	UV, MV
Azuma et al.^[25]	2013	Japan	UTUC	137	69.4 (40-88)	106:31	2.5	60.9 (1.9-187.3)	RFS, CSS	UV, MV
Kohada et al.^[11]	2018	Japan	UTUC	148	71 (64-78)^*	112:36	3	35.5 (12-66)^*	RFS, CSS	UV, MV
Tanaka et al.^[21]	2014	Japan	UTUC	665	70 (62-76)^*	493:172	3	28 (14-57)^*	RFS, CSS	UV, MV
Cao et al.^[16]	2017	China	UTUC	656	68 (39-88)	290:366	2.4	46 (12-144)	IVRFS, CSS	UV, MV
Cheng et al.^[18]	2016	China	UTUC	195	68±10.3	79:116	2.7	36	OS, CSS	UV, MV
Luo et al.^[22]	2014	China	UTUC	234	N	102:132	3	40.7±23.8	MFS, CSS	UV, MV
Tan et al.^[7]	2018	China	UTUC	717	67 (59-74)^*	408:309	2.5	42 (18-76)^*	OS, DFS, CSS, MFS	MV
Dalpiaz et al.^[23]	2014	Austria	UTUC	202	69.3 (32-85)	122:80	2.7	45 (0-199)	CSS, OS	UV, MV
Vartolomei et al.^[13]	2017	Austria	UTUC	2274	69 (61-76)	1527:747	2.7	40 (20-76)	RFS, CSS	UV, MV
Byun et al.^[19]	2016	Korea	RCC	1284	55.9±12.9	913:371	3.7	39 (19-69)^*	RFS, CSS	MV
Widz et al.^[2]	2020	Poland	RCC	196	61 (24-85)^*	116:80	2.69	68 (44.5-78)	OS	UV, MV
Agizamhann et al.^[12]	2018	China	RCC	82	37 (2-71)	33:49	2.45	31 (2-108)	OS, DFS	UV, MV
Chen et al.^[5]	2019	China	RCC	414	56.3 (24-80)	257:157	2.17	69.2 (1-151)	OS, CSS	MV
Wen et al.^[20]	2015	China	RCC	327	56 (3-86)	211:116	1.7	43 (0-97)	OS, DFS	UV, MV
Hu et al.^[15]	2017	China	RCC	484	56 (21-81)	278:206	2.78	36	OS	UV, MV
Gu et al.^[17]	2016	China	RCC	103	56 (16-79)	71:32	4.1	19.9 (10.8-35.1)^*	OS	UV, MV
Pichler et al.^[24]	2013	Austria	RCC	678	N	N	3.3	44 (0-130)	OS, CSS	UV, MV
Jang et al.^[3]	2016	Korea	Pca	2067	66 (61-70)	N	1.76	78 (65-6)^*	BCRFS, CSS, OS	UV, MV
Sun et al.^[8]	2018	China	Pca	226	N	N	2.31	24 (1-73)	OS, DFS	UV, MV
Viers et al.^[26]	2014	USA	Bca	899	69 (62-76)^*	723:176	2.7	130.8 (99.6-166.8)^*	DFS, CSS, OS	UV, MV
Tan et al.^[14]	2017	Singapore	Bca	84	67 (37-82)	63:21	2.7	30.1 (3.2-161.7)	DFS, OS	UV, MV
Kang et al.^[4]	2017	Korea	Bca	1551	65 (57-72)^*	1302:249	2	52 (27-82)^*	OS	UV, MV
Rajwa et al.^[10]	2018	Poland	Bca	144	N	N	3	14 (7-40)^*	OS, CSS	UV, MV
Vartolomei et al.^[6]	2018	Italy	Bca	1046	70 (29-91)	864:182	3	26 (10-47)^*	OS, DFS, CSS	MV

Table 1

Figure 2.

Table 2

Figure 3.

Table 3

Figure 4.

Figure 5.

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Subgroups	No. of studies	No. of patients	HR	95%CI	P_{heterogeneity}
Tumor type
RCC	7	2284	2.06	1.54-2.76	0.131
UTUC	3	1114	1.91	1.50-2.42	0.616
Bca	5	3724	1.09	1.02-1.17	<0.001
Pca	2	2293	1.69	1.19-2.41	0.714
Ethnicity
Asian	11	3165	1.89	1.58-2.25	0.203
Caucasian	6	6250	1.09	1.02-1.16	0.001
Cut-off value
< 2.7	8	5580	1.77	1.49-2.11	0.268
≥2.7	9	3835	1.15	1.05-1.26	<0.001
Overall	17	9415	1.40	1.26-1.54	<0.001

Subgroups	No. of studies	No. of patients	HR	95%CI	P_{heterogeneity}
Tumor type
RCC	3	2376	2.46	1.46-4.16	0.178
UTUC	10	6365	1.84	1.41-2.39	0.001
Bca	3	2089	1.05	1.01-1.09	0.163
Pca	1	2067	*	*	*
Ethnicity
Asian	11	7654	2.02	1.67-2.44	0.185
Caucasian	6	5243	1.06	1.00-1.12	0.049
Cut-off value
< 2.7	5	3991	2.10	1.68-2.61	0.349
≥2.7	12	8906	1.19	1.08-1.31	<0.001
Overall	17	12897	1.43	1.27-1.59	<0.001