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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic value of neutrophil-to-lymphocyte ratio in gastric cancer patients undergoing neoadjuvant chemotherapy: A systematic review and meta-analysis
Zhen-Hua Wei, Min Tuo, Chen Ye, Xiao-Fan Wu, Hong-Hao Wang, Wen-Zhen Ren, Gao Liu, Tian Xiang
Zhen-Hua Wei, Hubei Minzu University, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Min Tuo, Department of Breast Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Chen Ye, Xiao-Fan Wu, Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Hong-Hao Wang, Gao Liu, Department of Gastrointestinal Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Wen-Zhen Ren, Department of Abdominal Oncology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Tian Xiang, Department of Clinical Laboratory Center, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei Province, China
Co-first authors: Zhen-Hua Wei and Min Tuo.
Co-corresponding authors: Gao Liu and Tian Xiang.
Author contributions: All authors contributed to the study conception and design; Wei ZH contributed to the writing - original draft preparation; Wei ZH, Tuo M, Ye C, Liu G, and Xiang T were involved in the writing - review and editing; Wei ZH and Xiang T took part in the conceptualization; Ren WZ participated in the methodology of this manuscript; Wei ZH, Ye C, and Wu XF contributed to the formal analysis and investigation of this study; Tuo M, Liu G, and Xiang T contributed to the funding acquisition; Wang HH was involved in the resources of this study; Liu G and Xiang T took part in the supervision; and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Wei ZH and Tuo M contributed equally to this manuscript, they are the co-first authors of this study. Zhenhua Wei was responsible for data analysis and paper writing; Tuo M was responsible for data collection and compilation. Liu G and Xiang T contributed equally, they are the co-corresponding authors of this article. Liu G was responsible for writing guidance, review and project funding, and Xiang T was responsible for writing revision, review and project funding.
Supported by National Natural Science Foundation of China, No. 82360477 and No. 82060539; Natural Science Foundation of Hubei Province of China, No. 2022CFB344; the Scientific and Technological Project of Enshi Tujia and Miao Autonomous Prefecture of Hubei Province, No. D20220059; and “Selenium Engineering” Science and Technology Project of Enshi Tujia and Miao Autonomous Prefecture of Hubei Province, No. D20230071.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Gao Liu, PhD, Professor, Department of Gastrointestinal Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, No. 158 Wuyang Road, Enshi 445000, Hubei Province, China.
lgkinki@126.com
Received: July 16, 2024
Revised: September 10, 2024
Accepted: September 24, 2024
Published online: November 15, 2024
Processing time: 101 Days and 7.6 Hours
BACKGROUND
In recent studies, accumulating evidence has revealed a strong association between the inflammatory response and the prognosis of many tumors. There is a certain correlation of neutrophil-to-lymphocyte ratio (NLR) with the prognosis in gastric cancer (GC) patients undergoing neoadjuvant chemotherapy (NAC). However, the existing research results have remained controversial.
AIM
To explore the relationship between NLR ratio and prognosis of GC patients receiving NAC.
METHODS
A thorough systematic search was performed in databases such as PubMed, Embase, Web of Science, and Cochrane Library, the search is available until February 29, 2024, and studies exploring the interaction of NLR with clinical outcomes were collected. Relevant studies meeting pre-defined inclusion and exclusion criteria were carefully chosen. The outcomes included progression-free survival (PFS), relapse-free survival, disease-free survival (DFS), and overall survival (OS). The hazard ratio (HR) and its corresponding 95% confidence interval (CI) were utilized for estimation.
RESULTS
Our analysis encompassed 852 patients and incorporated data from 12 cohort studies. The comprehensive analysis revealed a significant association of high NLR with reduced OS (HR = 1.76; 95%CI: 1.22-2.54, P = 0.003), relapse-free survival (HR = 3.73; 95%CI: 1.74-7.96, P = 0.0007), and PFS (HR = 2.32; 95%CI: 1.42-3.81, P = 0.0008) in patients. However, this correlation in disease-free survival was not significant. NLR demonstrated its crucial role in effectively predicting the OS of GC patients undergoing NAC at different detection times, ages, regions, and NLR thresholds.
CONCLUSION
In GC patients receiving NAC, an elevated NLR is strongly associated with reduced OS and PFS. NLR has become an effective biomarker for patient prognosis evaluation, providing valuable insights for the treatment strategies of NAC in GC patients.
Core Tip: This study systematically evaluated the relationship between neutrophil to lymphocyte ratio (NLR) and prognosis in patients with gastric cancer (GC) receiving neoadjuvant chemotherapy (NAC). This is the first meta-analysis to evaluate the association between NLR and prognosis in patients with NAC for GC. In summary, NLR levels are highly correlated with the prognosis of GC patients receiving NAC, and NLR can be used as an effective biomarker for prognosis assessment of GC patients.
