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Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to predict oncologic outcomes in patients with various types of cancer. However, their prognostic value in patients with esophageal cancer is unclear. In this meta-analysis, we evaluated the prognostic significance of NLR and PLR in esophageal cancer patients.

Methods

We performed comprehensive searches of electronic databases to identify studies that evaluated the prognostic impact of pretreatment NLR and PLR in esophageal cancer patients. The end points were overall survival (OS), disease-free survival, and clinicopathologic parameters. A meta-analysis using random-effects models was performed to calculate hazard ratios (HRs) or odds ratios with 95 % confidence intervals (CIs).

Results

Seven retrospective, observational, cohort studies involving 1540 patients were included. All seven studies evaluated NLR, and four evaluated PLR. Both high NLR (HR 1.40, 95 % CI 1.08–1.81, P = 0.01) and high PLR (HR 1.59, 95 % CI 1.14–2.21, P = 0.006) were significantly predictive of poorer OS. NLR was not a significant predictor of disease-free survival. High PLR (HR 1.85, 95 % CI 1.50–2.28, P < 0.00001) but not NLR was significantly predictive of poorer OS in a subgroup of patients who underwent curative surgery without neoadjuvant chemoradiation. Both high NLR and high PLR were significantly associated with deeper tumor invasion and lymph node metastasis.

Conclusions

NLR and PLR are associated with tumor progression and are predictive of poorer survival in patients with esophageal cancer. These ratios may thus help to inform treatment decisions and predict treatment outcomes.

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The authors declare no conflict of interest.

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    Authors and Affiliations

    1. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

      Hariruk Yodying MD, Akihisa Matsuda MD, Masao Miyashita MD, Satoshi Matsumoto MD, Nobuyuki Sakurazawa MD & Marina Yamada PhD

    2. Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand

      Hariruk Yodying MD & Eiji Uchida MD

    3. Department of Surgery, Nippon Medical School, Tokyo, Japan

      Eiji Uchida MD

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    1. Hariruk Yodying MD
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    Correspondence to Akihisa Matsuda MD.

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    Hariruk Yodying and Akihisa Matsuda have contributed equally to this article, and both should be considered first author.

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    10434_2015_4869_MOESM1_ESM.pdf

    Flow diagram of literature search. Seven studies including a total of 1540 patients (published between 2011 and 2014) were included in the meta-analysis. NLR: neutrophil to lymphocyte ratio, PLR: platelet to lymphocyte ratio (PDF 328 kb)

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    Yodying, H., Matsuda, A., Miyashita, M. et al. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 23, 646–654 (2016). https://doi.org/10.1245/s10434-015-4869-5

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    • DOI: https://doi.org/10.1245/s10434-015-4869-5

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