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Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio in patients with laryngeal cancer: a systematic review and meta-analysis

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

The neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with the progression of laryngeal cancer (LC), but studies have reported inconsistent results. We systematically evaluated the effect of the pretreatment NLR on the prognosis of LC in the meta-analysis.

Method

The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from January 1, 2000 to September 10, 2019, to identify studies investigating the relationship between the NLR and outcomes in LC patients. The fixed-effects model was used to assess the pooled hazard ratio (HR), along with the 95% confidence interval (95% CI).

Results

A total of 105 records were obtained through the databases and 12 studies enrolling 3710 patients were included in the meta-analysis. The pooled overall survival (OS, HR = 1.76, 95% CI 1.53–2.03, P < 0.001), progression-free survival (PFS, HR = 1.72, 95% CI 1.38–2.13, P < 0.001) and disease-free survival (DFS, HR = 1.66, 95% CI 1.33–2.07, P < 0.001) indicated that a higher NLR led to a poorer prognosis for patients with LC. In terms of publication year, country, cutoff value, cutoff method, treatment modality, statistical model and NOS score, subgroup analyses consistently showed a worse OS in patients with an elevated NLR. Additionally, there was no significant difference among the subgroups (all P for heterogeneity > 0.05).

Conclusion

An elevated pretreatment NLR is significantly associated with poorer prognosis in patients with LC. NLR values are easily obtained from routinely collected blood samples and could assist clinicians in determining the prognosis of LC patients.

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Data availability

All data generated or analysed during this study are included in this published article.

Code availability

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References

  1. Chu EA, Kim YJ (2008) Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin N Am 41(4):673–695

    Article  Google Scholar 

  2. Schorn VJ, Miles BA (2014) Laryngeal squamous cell carcinoma. ENT Board Prep. Springer, New York, pp 227–233

    Chapter  Google Scholar 

  3. Maasland DHE, van den Brandt PA, Kremer B et al (2014) Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study. BMC Cancer 14(1):187

    Article  PubMed  PubMed Central  Google Scholar 

  4. Freedman ND, Abnet CC, Leitzmann MF et al (2007) Prospective investigation of the cigarette smoking—head and neck cancer association by sex. Cancer 110(7):1593–1601

    Article  PubMed  Google Scholar 

  5. Zuo JJ, Tao ZZ, Chen C et al (2017) Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies. Eur Arch Otorhinolaryngol 274(3):1617–1631

    Article  PubMed  Google Scholar 

  6. Ndiaye C, Mena M, Alemany L et al (2014) HPV DNA, E6/E7 mRNA, and p16INK4a detection in head and neck cancers: a systematic review and meta-analysis. Lancet Oncol 15(12):1319–1331

    Article  CAS  PubMed  Google Scholar 

  7. Obid R, Redlich M, Tomeh C (2019) The treatment of laryngeal cancer. Oral Maxillofac Surg Clin N Am 31(1):1–11

    Article  Google Scholar 

  8. Steuer CE, El-Deiry M, Parks JR et al (2017) An update on larynx cancer. CA Cancer J Clin 67(1):31–50

    Article  PubMed  Google Scholar 

  9. Santos TS, Estêvão R, Antunes L et al (2016) Clinical and histopathological prognostic factors in locoregional advanced laryngeal cancer. J Laryngol Otol 130(10):948–953

    Article  CAS  PubMed  Google Scholar 

  10. Siegel R, Ma J, Zou Z et al (2014) Cancer statistics. CA Cancer J Clin 64(1):9–29

    Article  PubMed  Google Scholar 

  11. Balch CM, Soong SJ, Gershenwald JE et al (2001) Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 19(16):3622–3634

    Article  CAS  PubMed  Google Scholar 

  12. Takes RP, Rinaldo A, Silver CE et al (2010) Future of the TNM classification and staging system in head and neck cancer. Head Neck 32(12):1693–1711

    Article  PubMed  Google Scholar 

  13. Mei Z, Shi L, Wang B et al (2017) Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev 58:1–13

    Article  PubMed  Google Scholar 

  14. Kang MH, Go SI, Song HN et al (2014) The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer. Br J Cancer 111(3):452–460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Fu SJ, Shen SL, Li SQ et al (2013) Prognostic value of preoperative peripheral neutrophil-to-lymphocyte ratio in patients with HBV-associated hepatocellular carcinoma after radical hepatectomy. Med Oncol 30(4):721

    Article  PubMed  CAS  Google Scholar 

  16. Chen L, Zeng H, Yang J et al (2018) Survival and prognostic analysis of preoperative inflammatory markers in patients undergoing surgical resection for laryngeal squamous cell carcinoma. BMC Cancer 18(1):816

    Article  PubMed  PubMed Central  Google Scholar 

  17. Du J, Liu J, Zhang X et al (2017) Pre-treatment neutrophil to lymphocyte ratio predicts survival in patients with laryngeal cancer. Oncol Lett 15(2):1664–1672

    PubMed  PubMed Central  Google Scholar 

  18. Wang J, Wang S, Song X et al (2016) The prognostic value of systemic and local inflammation in patients with laryngeal squamous cell carcinoma. Onco Targets Ther 9:7177

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fu Y, Liu W, OuYang D et al (2016) Preoperative neutrophil-to-lymphocyte ratio predicts long-term survival in patients undergoing total laryngectomy with advanced laryngeal squamous cell carcinoma: a single-center retrospective study. Medicine 95(6):e2689

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hsueh C, Tao L, Zhang M et al (2017) The prognostic value of preoperative neutrophils, platelets, lymphocytes, monocytes and calculated ratios in patients with laryngeal squamous cell cancer. Oncotarget 8(36):60514

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sheng X, Zhang H, Ge P et al (2019) A retrospective study of the prognostic significance of preoperative plasma fibrinogen, mean platelet volume, and the neutrophil-to-lymphocyte ratio in patients with laryngeal squamous cell carcinoma. Med Sci Monit 25:4527–4534

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Tu XP, Qiu QH, Chen LS et al (2015) Preoperative neutrophil-to-lymphocyte ratio is an independent prognostic marker in patients with laryngeal squamous cell carcinoma. BMC Cancer 15(1):743

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tu XP, Tian T, Chen LS et al (2018) Prognostic values of preoperative NLR and PLR in patients with laryngeal squamous cell carcinoma. Transl Cancer Res 7(2):301–309

    Article  CAS  Google Scholar 

  24. Xun Y, Wang M, Sun H et al (2019) Prognostic analysis of preoperative inflammatory biomarkers in patients with laryngeal squamous cell carcinoma. Ear Nose Throat J 99(6):371–378

    Article  PubMed  Google Scholar 

  25. Zeng YC, Chi F, Xing R et al (2016) Pre-treatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with locoregionally advanced laryngeal carcinoma treated with chemoradiotherapy. Jpn J Clin Oncol 46(2):126–131

    PubMed  Google Scholar 

  26. Eskiizmir G, Uz U, Onur E et al (2018) The evaluation of pretreatment neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio in patients with laryngeal neoplasms. Braz J Otorhinolaryngol 85(5):578–587

    Article  PubMed  Google Scholar 

  27. Wong BYW, Stafford ND, Green VL et al (2015) Prognostic value of the neutrophil-to-lymphocyte ratio in patients with laryngeal squamous cell carcinoma. Head Neck 38(S1):E1903–E1908

    Article  PubMed  Google Scholar 

  28. Kara M, Uysal S, Altinişik U et al (2017) The pre-treatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and red cell distribution width predict prognosis in patients with laryngeal carcinoma. Eur Arch Otorhinolaryngol 274(1):535–542

    Article  PubMed  Google Scholar 

  29. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605

    Article  PubMed  Google Scholar 

  30. Smith HA, Kang Y (2013) The metastasis-promoting roles of tumor-associated immune cells. J Mol Med 91(4):411–429

    Article  CAS  PubMed  Google Scholar 

  31. Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420(6917):860

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gastardelo TS, Cunha BR, Raposo LS et al (2014) Inflammation and cancer: role of annexin A1 and FPR2/ALX in proliferation and metastasis in human laryngeal squamous cell carcinoma. PLoS ONE 9(12):e111317

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Grivennikov SI, Greten FR, Karin M (2010) Immunity, inflammation, and cancer. Cell 140(6):883–899

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Meng CD, Zhu DD, Jiang XD et al (2012) Overexpression of interleukin-l7 in tumor-associated macrophages is correlated with the differentiation and angiogenesis of laryngeal squamous cell carcinoma. Chin Med J 125(9):1603–1607

    CAS  PubMed  Google Scholar 

  35. Kum RO, Ozcan M, Baklaci D et al (2014) Elevated neutrophil-to-lymphocyte ratio in squamous cell carcinoma of larynx compared to benign and precancerous laryngeal lesions. Asian Pac J Cancer Prev 15(17):7351–7355

    Article  PubMed  Google Scholar 

  36. Duzlu M, Karamert R, Tutar H et al (2015) Neutrophil-lymphocyte ratio findings and larynx carcinoma: a preliminary study in Turkey. Asian Pac J Cancer Prev 16(1):351–354

    Article  PubMed  Google Scholar 

  37. Templeton AJ, Knox JJ, Lin X et al (2016) Change in neutrophil-to-lymphocyte ratio in response to targeted therapy for metastatic renal cell carcinoma as a prognosticator and biomarker of efficacy. Eur Urol 70(2):358–364

    Article  PubMed  Google Scholar 

  38. Yang L, Huang Y, Zhou L et al (2019) High pretreatment neutrophil-to-lymphocyte ratio as a predictor of poor survival prognosis in head and neck squamous cell carcinoma: systematic review and meta-analysis. Head Neck 41(5):1525–1535

    Article  PubMed  Google Scholar 

  39. Mascarella MA, Mannard E, Silva SD et al (2018) Neutrophil-to-lymphocyte ratio in head and neck cancer prognosis: a systematic review and meta-analysis. Head Neck 40(5):1091–1100

    Article  PubMed  Google Scholar 

  40. Yu Y, Wang H, Yan A et al (2018) Pretreatment neutrophil to lymphocyte ratio in determining the prognosis of head and neck cancer: a meta-analysis. BMC Cancer 18(1):383

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cho JK, Kim MW, Choi IS et al (2018) Optimal cutoff of pretreatment neutrophil-to-lymphocyte ratio in head and neck cancer patients: a meta-analysis and validation study. BMC Cancer 18(1):969

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Clinical Laboratory Medicine of Yongchuan Hospital, Chongqing Medical University, No. 439, Xuanhua Road, Yongchuan District, Chongqing, 402160, China

    Fangyu Yang, Qianyi Huang & Qizhi Diao

  2. Clinical Laboratory Medicine of Affiliated Hospital 2, Liaoning University Traditional Chinese Medicine, Liaoning, China

    Zhongying Guan

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  1. Fangyu Yang
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  2. Qianyi Huang
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  4. Qizhi Diao
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Contributions

FYY designed the study, performed data analyses and wrote the manuscript. FYY and QYH collected the data and performed quality control of the raw data. ZYG and QZD were responsible for ensuring that all aspects of the study are accurate.

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Correspondence to Qizhi Diao.

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The authors declare that they have no competing interests.

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Ethics approval and consent to participate were not required for this study, because participants have not been directly affected.

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Electronic supplementary material

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405_2020_6337_MOESM1_ESM.tif

Supplementary file1 (A) Egger linear regression test and (B) Funnel plot of publication bias test for overall survival (OS) in patients with laryngeal cancer (LC) (TIF 420 kb)

405_2020_6337_MOESM2_ESM.tif

Supplementary file2 Sensitivity analysis of neutrophil-to-lymphocyte ratios (NLR) in patients with laryngeal cancer (LC) in studies. (A) including evaluation of overall survival (OS); (B) including evaluation of progression-free survival (PFS); (C) including evaluation of disease-free survival (DFS) (TIF 595 kb)

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Yang, F., Huang, Q., Guan, Z. et al. Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio in patients with laryngeal cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 278, 417–425 (2021). https://doi.org/10.1007/s00405-020-06337-5

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  • DOI: https://doi.org/10.1007/s00405-020-06337-5

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