Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Although neutrophils have been linked to the progression of cancer, uncertainty exists around their association with cancer outcomes, depending on the site, outcome and treatments considered. We aimed to evaluate the strength and validity of evidence on the association between either the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis.

Methods

We searched MEDLINE, Embase and Cochrane Database of Systematic Reviews from inception to 29 May 2020 for systematic reviews and meta-analyses of observational studies on neutrophil counts (here NLR or TAN) and specific cancer outcomes related to disease progression or survival. The available evidence was graded as strong, highly suggestive, suggestive, weak or uncertain through the application of pre-set GRADE criteria.

Results

A total of 204 meta-analyses from 86 studies investigating the association between either NLR or TAN and cancer outcomes met the criteria for inclusion. All but one meta-analyses found a hazard ratio (HR) which increased risk (HR > 1). We did not find sufficient meta-analyses to evaluate TAN and cancer outcomes ( N = 9). When assessed for magnitude of effect, significance and bias related to heterogeneity and small study effects, 18 (9%) associations between NLR and outcomes in composite cancer endpoints (combined analysis), cancers treated with immunotherapy and some site specific cancers (urinary, nasopharyngeal, gastric, breast, endometrial, soft tissue sarcoma and hepatocellular cancers) were supported by strong evidence.

Conclusion

In total, 60 (29%) meta-analyses presented strong or highly suggestive evidence. Although the NLR and TAN hold clinical promise in their association with poor cancer prognosis, further research is required to provide robust evidence, assess causality and test clinical utility.

Trial registration

PROSPERO CRD42017069131.

Related collections

Most cited references 95

Record: found
Abstract: found
Article: found

Hallmarks of Cancer: The Next Generation

Douglas Hanahan, Robert A. Weinberg (2011)

The hallmarks of cancer comprise six biological capabilities acquired during the multistep development of human tumors. The hallmarks constitute an organizing principle for rationalizing the complexities of neoplastic disease. They include sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, and activating invasion and metastasis. Underlying these hallmarks are genome instability, which generates the genetic diversity that expedites their acquisition, and inflammation, which fosters multiple hallmark functions. Conceptual progress in the last decade has added two emerging hallmarks of potential generality to this list-reprogramming of energy metabolism and evading immune destruction. In addition to cancer cells, tumors exhibit another dimension of complexity: they contain a repertoire of recruited, ostensibly normal cells that contribute to the acquisition of hallmark traits by creating the "tumor microenvironment." Recognition of the widespread applicability of these concepts will increasingly affect the development of new means to treat human cancer. Copyright © 2011 Elsevier Inc. All rights reserved.

0 comments Cited 11946 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Measuring inconsistency in meta-analyses.

Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)

0 comments Cited 10194 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

Gordon Guyatt, Andrew D Oxman, Gunn E. Vist … (2008)

0 comments Cited 3866 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Antonio J. Berlanga-Taylor:

ORCID: http://orcid.org/0000-0002-4199-7332

a.berlanga@imperial.ac.uk

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 20 November 2020

Publication date PMC-release: 20 November 2020

Publication date Collection: 2020

Volume: 18

Electronic Location Identifier: 360

Affiliations

[1 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, , Imperial College London, ; St Mary’s Campus, Norfolk Place, London, W21PG UK

[2 ]GRID grid.9594.1, ISNI 0000 0001 2108 7481, Department of Hygiene and Epidemiology, , University of Ioannina Medical School, ; Ioannina, Greece

[3 ]Department of Nutrition, Bjørknes University College, Oslo, Norway

[4 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Department of Endocrinology, Morbid Obesity and Preventive Medicine, , Oslo University Hospital, ; Oslo, Norway

Author information

Antonio J. Berlanga-Taylor http://orcid.org/0000-0002-4199-7332

Article

Publisher ID: 1817

DOI: 10.1186/s12916-020-01817-1

PMC ID: 7678319

PubMed ID: 33213430

SO-VID: 3fb35957-7325-45ad-9660-45ad83c92d65

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 April 2020

Date accepted : 15 October 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;

Award ID: MR/L01632X/1

Award Recipient : Antonio J. Berlanga-Taylor

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: cancer,neutrophils,neutrophil to lymphocyte ratio,tumour-associated neutrophils,prognosis,umbrella review

Data availability:

ScienceOpen disciplines: Medicine

Keywords: cancer, neutrophils, neutrophil to lymphocyte ratio, tumour-associated neutrophils, prognosis, umbrella review

Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies

Read this article at

Abstract

Background

Methods

Results

Conclusion

Trial registration

Related collections

Karger: Oncology

Most cited references 95

Hallmarks of Cancer: The Next Generation

Measuring inconsistency in meta-analyses.

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 454

Cited by 135

Most referenced authors 2,324