Annals of Surgical Oncology

, Volume 23, Issue 2, pp 646–654 | Cite as

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

  • Hariruk Yodying
  • Akihisa MatsudaEmail author
  • Masao Miyashita
  • Satoshi Matsumoto
  • Nobuyuki Sakurazawa
  • Marina Yamada
  • Eiji Uchida
Thoracic Oncology



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.


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).


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.


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.


Overall Survival Esophageal Cancer Esophageal Cancer Patient Poor Overall Survival Significant Publication Bias 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.

Supplementary material

10434_2015_4869_MOESM1_ESM.pdf (328 kb)
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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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Hariruk Yodying
    • 1
    • 2
  • Akihisa Matsuda
    • 1
    Email author
  • Masao Miyashita
    • 1
  • Satoshi Matsumoto
    • 1
  • Nobuyuki Sakurazawa
    • 1
  • Marina Yamada
    • 1
  • Eiji Uchida
    • 2
    • 3
  1. 1.Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
  2. 2.Department of Surgery, Faculty of MedicineSrinakharinwirot UniversityBangkokThailand
  3. 3.Department of SurgeryNippon Medical SchoolTokyoJapan

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