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. 2019 Jun;8(3):214-226.
doi: 10.21037/tlcr.2019.06.10.

Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis

Zimu Wang  1 , Ping Zhan  1 , Yanling Lv  2 , Kaikai Shen  3 , Yuqing Wei  1 , Hongbing Liu  1 , Yong Song  1
Affiliations

Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis

Zimu Wang et al. Transl Lung Cancer Res. 2019 Jun.

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is related to prognosis in non-small cell lung cancer (NSCLC). However, no consensus on the relationship of pretreatment NLR and survival outcomes of systemic therapy in NSCLC exists. This meta-analysis investigated the prognostic role of pretreatment NLR during systemic therapy for NSCLC, including chemotherapy, immunotherapy and targeted therapy.

Methods: PubMed, Web of Science and Cochrane Library databases were systematically searched up to April 09, 2019. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were pooled to investigate the association of pretreatment NLR with progression-free survival (PFS) and overall survival (OS).

Results: In total, 27 articles with 4,298 participants were selected. The pooled results showed that elevated pretreatment NLR was associated with inferior PFS (HR, 1.45, 95% CI, 1.28-1.66) and OS (HR, 1.63, 95% CI, 1.43-1.84) during systemic therapy. Subgroup analyses according to the treatment strategy suggested that higher pretreatment NLR was significantly associated with shorter survival in all therapies, including chemotherapy (PFS HR, 1.74, 95% CI, 1.39-2.17; OS HR, 1.73, 95% CI, 1.26-2.36), immunotherapy (PFS HR, 1.53, 95% CI, 1.27-1.84; OS HR, 2.50, 95% CI, 1.60-3.89) and targeted therapy (PFS HR, 1.53, 95% CI, 1.04-2.25; OS HR, 1.92, 95% CI, 1.14-3.24).

Conclusions: Pretreatment NLR is a promising prognostic indicator for NSCLC patients receiving systemic therapy, including chemotherapy, immunotherapy and targeted therapy.

Keywords: Chemotherapy; immunotherapy; lung neoplasms; molecular targeted therapy; neutrophil-to-lymphocyte ratio (NLR).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of study identification and selection.
Figure 2
Figure 2
Forest plot of studies investigating the association of pretreatment NLR and PFS with subgroup analysis stratified by treatment strategy. HR, hazard ratio; CI, confidence interval; NLR, neutrophil-to-lymphocyte ratio; PFS, progression-free survival.
Figure 3
Figure 3
Forest plot of studies investigating the association of pretreatment NLR and OS with subgroup analysis stratified by treatment strategy. HR, hazard ratio; CI, confidence interval; NLR, neutrophil-to-lymphocyte ratio; OS, overall survival.
Figure S1
Figure S1
PFS funnel plot. PFS, progression-free survival.
Figure S2
Figure S2
OS funnel plot. OS, overall survival.
See this image and copyright information in PMC

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