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Review
. 2015 Apr 8;5(4):e006404.
doi: 10.1136/bmjopen-2014-006404.

Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis

Kaimin Hu  1 , Lixia Lou  2 , Juan Ye  2 , Suzhan Zhang  1
Affiliations
Review

Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis

Kaimin Hu et al. BMJ Open. .

Abstract

Objective: Increasing evidence suggests that cancer-associated inflammation is associated with poor prognosis in patients with cancer. The role of the neutrophil-lymphocyte ratio (NLR) as a predictor in renal cell carcinoma (RCC) remains controversial. We conducted the meta-analysis to determine the association between NLR and clinical outcome of patients with RCC.

Methods and materials: Studies were identified from PubMed and EMBASE databases in March 2014. Meta-analysis was performed to generate combined HRs with 95% CIs for overall survival (OS) and recurrence-free/progress-free survival (RFS/PFS).

Results: 15 cohorts containing 3357 patients were included. Our analysis results indicated that elevated NLR predicted poorer OS (HR=1.82, 95% CI 1.51 to 2.19) and RFS/PFS (HR=2.18, 95% CI 1.75 to 2.71) in patients with RCC. These findings were robust when stratified by study region, sample size, therapeutic intervention, types of RCC and study quality. However, it differed significantly by assessment of the cut-off value defining 'elevated NLR' in RFS/PFS (p=0.004). The heterogeneity in our meta-analysis was mild to moderate.

Conclusions: Elevated NLR indicates a poorer prognosis for patients with RCC. NLR should be monitored in patients with RCC for rational risk stratification and treatment individualisation.

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Figures

Figure 1
Figure 1
Flow chart of study selection process (CRP, C reactive protein; NLR, neutrophil–lymphocyte ratio; RCC, renal cell carcinoma).
Figure 2
Figure 2
Meta-analysis of the association between elevated NLR and OS of RCC. Results are presented as individual and pooled HR and 95% CI (NLR, neutrophil-lymphocyte ratio; OS, overall survival; RCC, renal cell carcinoma).
Figure 3
Figure 3
Meta-analysis of the association between elevated NLR and RFS/PFS of RCC. Results are presented as individual and pooled HR and 95% CI (NLR, neutrophil-lymphocyte ratio; RCC, renal cell carcinoma, RFS/PFS, recurrence-free/progress-free survival).
Figure 4
Figure 4
Funnel plots without and with trim and fill. The pseudo 95% CI is computed as part of the analysis that produces the funnel plot, and corresponds to the expected 95% CI for a given SE (OS, overall survival; RFS/PFS, recurrence-free/progress-free survival).
See this image and copyright information in PMC

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