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Review
. 2022 Feb 25;12(3):593.
doi: 10.3390/diagnostics12030593.

Systematic Review of Prognostic Role of Blood Cell Ratios in Patients with Gastric Cancer Undergoing Surgery

Sabine Schiefer  1 , Naita Maren Wirsik  2 , Eva Kalkum  3 , Svenja Elisabeth Seide  4 , Henrik Nienhüser  1 , Beat Müller  1 , Adrian Billeter  1 , Markus W Büchler  1 , Thomas Schmidt  1   2 , Pascal Probst  1   3   5
Affiliations
Review

Systematic Review of Prognostic Role of Blood Cell Ratios in Patients with Gastric Cancer Undergoing Surgery

Sabine Schiefer et al. Diagnostics (Basel). .

Abstract

Various blood cell ratios exist which seem to have an impact on prognosis for resected gastric cancer patients. The aim of this systematic review was to investigate the prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery in a curative attempt. A systematic literature search in MEDLINE (via PubMed), CENTRAL, and Web of Science was performed. Information on survival and cut-off values from all studies investigating any blood cell ratio in resected gastric cancer patients were extracted. Prognostic significance and optimal cut-off values were calculated by meta-analyses and a summary of the receiver operating characteristic. From 2831 articles, 65 studies investigated six different blood cell ratios (prognostic nutritional index (PNI), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)). There was a significant association for the PNI and NLR with overall survival and disease-free survival and for LMR and NLR with 5-year survival. The used cut-off values had high heterogeneity. The available literature is flawed by the use of different cut-off values hampering evidence-based patient treatment and counselling. This article provides optimal cut-off values recommendations for future research.

Keywords: blood cell ratios; confounder; gastric cancer; prognostic studies.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing selection of included articles for review. Abbreviation: PNI: Prognostic nutritional index; LMR: Lymphocyte to monocyte ratio; SII: Systemic immune-inflammation index; MLR: Monocyte to lymphocyte ratio; NLR: Neutrophil to lymphocyte ratio; and PLR: Platelet to lymphocyte ratio.
Figure 2
Figure 2
Funnel plot for PLR showing significant asymmetry, indicating a publication bias.
Figure 3
Figure 3
Forest plot for OS for (A) PNI, (B) LMR, (C) SII, and (D) MLR.
Figure 4
Figure 4
Forest plot for OS for (A) NLR and (B) PLR.
See this image and copyright information in PMC

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