Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Inclusion Criteria
- The studies must discuss the survival outcome of HNC cancer patients based on PLR, NLR and MLR levels.
- The survival outcome must be presented in the form of HR (hazard ratios) and 95% CI (confidence intervals).
- The survival outcome must be presented in the form of Kaplan–Meier curves, along with patient cohort information, for each treatment arm represented in the KM Curves. (This is required only if the HR and 95% CI values have not been presented in the manuscript, as the above information is required to extract approximated HR values.)
2.4. Exclusion Criteria
- Conference abstracts, reviews, letters to the editor and other non-clinical literature will not be considered for either systematic review or meta-analysis.
- Included studies must be clinical studies or involve patient samples. (In vitro, in silico and animal studies will be excluded.)
- Unpublished or non-peer-reviewed literature will be excluded.
- Studies that do not focus on survival outcomes and prognosis aspects of PLR, NLR and MLR in cancer patients will not be considered.
- If the sample size of each individual study is of low power (sample size < 10), they will be excluded.
2.5. Data Extraction and Recording
- Author names;
- Year of publication;
- Marker studied (PLR, NLR or MLR);
- Size of patient cohort;
- Diagnostic methods;
- Follow-up period;
- Gender split of cohort;
- TNM staging split of cohort;
- Survival endpoint of each study (overall survival, disease-free survival, disease-specific survival);
- General features of each study (will be presented as short qualitative opinions/observations of reviewers, for each study being included).
2.6. Quality Assessment
2.7. Meta-Analysis
2.8. Assessment of Heterogeneity
2.9. Subgroup Analysis
2.10. Publication Bias
3. Results
4. Meta-Analysis
4.1. Meta-Analysis PLR Subgroup
4.2. Meta-Analysis NLR Subgroup
4.3. Meta-Analysis MLR Subgroup
4.4. Publication Bias
4.5. Quality Assessment
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Author Name | Year of Publication | Prognostic Parameter (PLR/NLR/MLR) | Cohort Size | Anatomic Location of Cancer | Country of Study | Type of Study | Gender | Stage of Cancer | Metastasis | Risk Factors | Age |
---|---|---|---|---|---|---|---|---|---|---|---|
Wen et al. [47] | 2018 | PLR NLR | 723 | Esophageal (65%) Gastric (35%) | UK | retrospective study | male (75.5%) female (24.5%) | T0 (4.6%) T1 (14.4%) T2 (21.0%) T3 (51.9%) T4 (8.2%) | M1 2.5% | NA | 66.1 ± 10.5 |
Kawakita et al. [48] | 2016 | PLR NLR | 140 | Parotid gland (78%) Submandibular gland (20%) Others (2%) | Japan | retrospective study | male (86%) female (14%) | T1 (9%) T2 (26%) T3 (20%) 4a (44%) 4b (1%) | M0 (93%) M1 (7%) | NA | 64 (26–84) |
Chen et al. [49] | 2014 | NLR PLR | 211 | Nasopharynx (100%) | China | retrospective study | male (85.8%) female (14.2%) | NA | NA | NA | 46 (14–72) |
Zhang et al. [50] | 2015 | NLR PLR | 468 | Esophagus (100%) | China | retrospective study | male (80.3%) female (19.7%) | stage I (9.8 %) stage II (42.6 %) stage III (47.6 %) | NA | Smoking Alcohol consumption | 59.5 ± 9.0 |
Jiang et al. [51] | 2017 | PLR NLR LMR | 78 | Thyroid (100%) | China | retrospective study | male (43.6%) female (56.4%) | stage I (23.1%) stage II (20.5%) stage III (20.5%) stage IV (35.9%) | M1 (2.6%) | NA | 47.3 ± 13.8 |
Li et al. [52] | 2016 | PLR NLR LMR | 388 | Nasopharynx (100%) | China | retrospective study | NA | NA | M0 (100%) | NA | |
Feng et al. [53] | 2014 | NLR PLR | 483 | Esophagus (100%) | China | retrospective study | male (85.1%) female (14.9%) | T1 (18.0%) T2 (16.6%) T3 (54.9%) T4 (10.5%) | M0 (56.7%) M1 (43.3%) | NA | 59.1 ± 8.0 |
Jiang et al. [54] | 2015 | PLR | 1261 | Nasopharynx (100%) | China | retrospective study | male (72.9%) female (27.1%) | Clinical stage I (3.25) II (14.8%) III (52.7%) IV (29.4%) Tumor stage T1 (8.6%) T2 (23.6%) T3 (46.2%) T4 (21.5%) Node stage N0 (16.8%) N1 (36.6%) N2 (37.7%) N3 (9.0%) | M1 (12.4) M0 (87.6) | Smoking Chronic HBV infection Cardiovascular disease Diabetes mellitus Family history of NPC | 46 (39–55) |
Jung et al. [55] | 2015 | NLR PLR | 119 | Esophagus (100%) | Korea | retrospective study | male (94.1%) female (5.9%) | Pathological stage I (31.1%) II 33 (27.7%) III 49 (41.2) | M0 (100%) | NA | 63.64 ± 8.42 |
He et al. [56] | 2016 | NLR PLR | 317 | Esophagus (100%) | China | retrospective study | male (84.5%) female (15.5%) | TNM I–II (68.5%) III–IV (31.5%) | M0 (53.9%) M1 (46.1%) | Smoking Alcohol consumption | 60 (37–77) |
Jiang et al. [57] | 2016 | NLR PLR | 70 | Thyroid (100%) | China | retrospective study | male (40%) female (60%) | Stage III or IV (50.0%) | M1 (2.9%) | NA | 47.7 ± 13.9 |
Hirahara et al. [58] | 2017 | LMR NLR PLR | 147 | Esophagus (100%) | Japan | retrospective study | male (89.8%) female (10.2% | Pathological stage Ia–1b (40.1%) 2a–2b (22.4%) 3a–3c (37.4%) | NA | NA | NA |
Ong et al. [59] | 2016 | LMR NLR PLR | 133 | Tongue (100%) | China | retrospective study | male (53.4%) female (46.6%) | pT classification, n (%) T1 (39.1%) T2 (60.9%) | M0 (96.2%) M1 (3.8%) | NA | 51.92 (24–74) |
Mao et al. [60] | 2017 | PLR | 899 | Larynx (100%) | China | retrospective study | male (97.1%) female (2.9%) | T 1 (22.9%) 2 (28.9%) 3 (29.1%) 4 (19.0%) N 0 (81.2%) 1 (9.7%) 2 (8.6%) 3 (0.6%) | M0 (100%) | Smoking Alcohol consumption | 60 (22–87) |
Dutta et al. [61] | 2011 | NLR PLR | 112 | Esophagus (100%) | UK | retrospective study | male (75.9%) female (24.1%) | TNM stage I 17.9% II 34.8% III 46.4% IV 0.9% | NA | NA | <65 (60.7%) 65–74 (33.9%) ≥75 (5.4%) |
Li et al. [62] | 2016 | NLR PLR | 409 | Nasopharynx (100%) | China | retrospective study | male (70.4%) female (29.6%) | (I–II) (18.8%) (III–IV) (81.2%) | M0 (84.4%) M1 (15.6%) | NA | 45 (18–77) |
Messager et al. [63] | 2015 | PLR | 153 | Esophagus (100%) | UK | live patient samples | male (83.7%) female (16.3%) | ||||
Hirahara et al. [64] | 2016 | LMR NLR PLR | 147 | Esophagus (100%) | Japan | retrospective study | male (89.8%) female (10.2%) | Pathological stage Ia–Ib 40.1% IIa–Iib 22.5% IIIa–IIIc 37.4% | NA | NA | NA |
Moon et al. [65] | 2015 | NLR PLR | 153 | Oropharynx 33.3% Nasopharynx 31.4% Larynx 18.3% Hypopharynx 17.0% | Korea | live patient samples | male (84.3%) female (15.7%) | Clinical TNM stage T1/T2 17.6%/36.6% T3/T4 14.4%/31.4% N0/N1 21.6%/20.9% N2/N3 49.7%/7.8% Overall I/II 4.6%/17.0% Overall III/IV 13.7%/64.75% | M0 (100%) | Smoking Alcohol consumption | 57 (16–78) |
Hirahara et al. [66] | 2016 | LMR NLR PLR | 147 | Esophagus (100%) | Japan | retrospective study | male (89.8%) female (10.2%) | pathological stage 1a–1b (40.2%) 2a–2b (22.4%) 3a–3c (37.4%) | NA | NA | |
Turri–Zanoni et al. [67] | 2016 | NLR PLR | 215 | Paranasal sinus (100%) | Italy | retrospective study | male (34%) female (66%) | pT classification pT1 19% pT2 18% pT3 22% pT4a 16% pT4b 25% | M0 (100%) | NA | 65 (8–87) |
Xie et al. [68] | 2014 | NLR PLR | 317 | Esophagus (100%) | China | retrospective study | male (77%) female (23%) | Tumor stage Stage I 88.4 Stage II 69.7 Stage III 42.4 | M0 (100%) | NA | 58.1 ± 8.9 |
Bojaxhiu et al. [69] | 2018 | NLR PLR | 186 | Oral cavity (28%) Oropharynx (45%) Hypopharynx (15%) Larynx (13%) | Switzerland | retrospective study | male (79%) female (22%) | UICC stage, N (%) I (3%) II (6%) III (24%) IV (68%) | M0 (100%) | Smoking Alcohol consumption | 61 (41–88) |
Sun et al. [70] | 2017 | NLR PLR | 148 | Nasopharynx (100%) | China | retrospective study | male (83.8%) female (16.2%) | M0 (100%) | Smoking | 45 (24–72) | |
Sun et al. [71] | 2015 | NLR PLR | 251 | Nasopharynx (100%) | China | retrospective study | male (71.7%) female (28.3%) | UICC/AJCC stage I 2.4% II 15.9% III 47.4% IV 34.3% | M0 (100%) | NA | 46 (15–76) |
Tangthongkum et al. [72] | 2017 | PLR | 274 | Oral (100%) | Thailand | retrospective study | males (64.4%) females (35.6%) | NA | NA | NA | 60 (21–92) |
Ozturk et al. [73] | 2016 | NLR PLR | 57 | Tongue (100%) | Turkey | retrospective study | male (38.6%) female (61.4%) | stage I (64.9 %) stage II (35.1 %) | M0 (100%) | NA | 57.8 (23–88) |
Toyokawa et al. [74] | 2016 | NLR PLR | 185 | Esophagus (100%) | Japan | retrospective study | male (82.2 %) female (17.8%) | Clinical TNM stage I 36.2% II 42.2% III/IV 21.6% | M0 (100%) | NA | <65 51.4% ≥65 48.6% |
Urabe et al. [75] | 2017 | LMR NLR PLR | 1363 | Resectable Gastric and Esophagogastric Junction | Japan | retrospective study | male (71.5%) female (28.5%) | T stage T1 58% T2 11.8% T3 17.6% T4 12.6% | M0 (100%) | NA | NA |
Wang et al. [76] | 2014 | PLR | 252 | Upper aerodigestive tract | China | retrospective study | male (68.7%) female (31.3%) | Ann Arbor stage IE 61.5% IIE 38.5 % | NA | NA | 41 (9–80) |
Wei et al. [77] | 2015 | NLR PLR | 423 | Esophagus (100%) | China | retrospective study | male (80.6%) female (19.4) | TNM stage (AJCC, 7th) I (12.8%) II (39.7%) III (33.6%) IV (13.9%) | M0 (86.1) M1 (13.9) | NA | 58 (24–88) |
Xu et al. [78] | 2015 | NLR PLR | 468 | Esophagus (100%) | China | retrospective study | male (88.9%) female (11.1%) | Clinical stage I II IIIA IIIB + IIIC | NA | Smoking Alcohol consumption | 58 |
Yang et al. [79] | 2018 | NLR PLR | 515 | Esophagus (100%) | China | retrospective study | male (81.2%) female (18.8%) | TNM Stage I II III | M0 (100%) | NA | 61(33–92) |
Ye et al. [80] | 2018 | NLR PLR | 427 | Nasopharynx (100%) | China | retrospective study | male (71.9%) female (28.1%) | TNM stage I 2.1 II 18.7% III 48.7% IV 30.5% | yes | NA | 48 (17–82) |
Yuan et al. [81] | 2014 | NLR PLR | 327 | Esophagogastric junction (100%) | China | retrospective study | male (86.2%) female(13.8%) | pTNM stage I and II (45.9%) III and IV (54.1%) | yes | NA | 63.1± 9.7 (39–77) |
Zhang et al. [82] | 2017 | NLR PLR | 355 | Esophagogastric junction (100%) | China | retrospective study | male (79.2%) female (20.8%) | TNM stage I, II (43.4%) III, IV (56.6%) | NA | NA | 64 (34–82) |
Chen et al. [20] | 2018 | NLR PLR MLR | 361 | Larynx (100%) | China | retrospective study | male (97.8%) female (2.2%) | TNM stage I 31.6% II 32.7% III 19.7% IV 16.0% | yes | NA | 60 (35–87) |
Hsu et al. [83] | 2009 | MLR | 1069 | Esophagus (100%) | Taiwan | retrospective study | male (94.5%) female (5.5%) | stage I 53 (10.9%) II 197 (40.4%) III 138 (28.3%) IV 100 (20.5%) | yes | NA | 63.8 (34–88) |
Chien et al. [84] | 2016 | MLR | 2025 | Esophagus (100%) | Taiwan | retrospective study | male (94.1%) female (5.9%) | cStage T1–2N0 T3–4N0 T1–2N (+) T3–4N (+) Unknown | yes | NA | 55.2 ± 9.8 |
Furukawa et al. [85] | 2019 | LMR | 103 | Tongue (100%) | Japan | retrospective study | male (53.8%) female (46.2%) | stage I, II 84.5% III, IV 15.5% | yes | Smoking Alcohol consumption | 63 (26–92) |
Hsueh et al. [86] | 2017 | NLR PLR LMR | 979 | Larynx (100%) | China | retrospective study | male (97.5%) female (2.5%) | stage I 23.7% II 36.4% III 26.8% IV 13.1% | yes | NA | 60.81 ± 9.68 |
Huang et al. [87] | 2015 | LMR | 348 | Esophagus (100%) | China | retrospective study | male (87.1%) female (12.9%) | NA | yes | NA | 59.2 ±7.8 |
Kano et al. [88] | 2016 | NLR PLR LMR | 285 | Larynx (23.5%) Oropharynx (40.7%) Hypopharynx (35.8%) | Japan | retrospective study | male (88.4%) female (11.6%) | Clinical stage I, II (22.1%) III, IV (77.9%) | no | NA | 61 (37–80) |
Li et al. [89] | 2013 | LMR | 1547 | Nasopharynx (100%) | China | retrospective study | male 72.7% female 27.3% | Overall stage I-II (21.6%) III-IV (78.4%) | yes | NA | 51 (6–87) |
Li et al. [52] | 2017 | NLR PLR LMR | 249 | Nasopharynx (100%) | China | prospective study | male (73.9%) female (26.1%) | Clinical stage I-II 26.1 III-IV 73.9 | yes | NA | ≤50 (65.9%) >50 (34.1%) |
Liu et al. [90] | 2015 | NLR PLR LMR | 326 | Esophagus (100%) | China | retrospective study | male (86.8%) female (13.2%) | T stage T1 (18.1%) T2 (18.4%) T3 (53.7%) T4 (9.8%) | NA | NA | 59.2 ± 7.9 (38–80) |
Oya et al. [91] | 2018 | NLR PLR LMR | 441 | Oral cavity 44% Larynx 28% Oropharynx 10% Hypopharynx 13 % Other 5% | Japan | retrospective study | male (73%) female (27%) | Stage I 32% II 18% III 15% IV 35% | no | NA | 68 (27–92) |
Yang et al. [92] | 2018 | NLR LMR | 197 | Hypopharyngeal (100%) | China | retrospective study | male (99.0%) female (0.01%) | Clinical stage I (2.0%) II (13.2%) III (27.5%) IV (57.4%) | yes | Smoking Drinking | <59 (50.8%) ≥59 (49.2%) |
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Kumarasamy, C.; Tiwary, V.; Sunil, K.; Suresh, D.; Shetty, S.; Muthukaliannan, G.K.; Baxi, S.; Jayaraj, R. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166. https://doi.org/10.3390/cancers13164166
Kumarasamy C, Tiwary V, Sunil K, Suresh D, Shetty S, Muthukaliannan GK, Baxi S, Jayaraj R. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers. 2021; 13(16):4166. https://doi.org/10.3390/cancers13164166
Chicago/Turabian StyleKumarasamy, Chellan, Vaibhav Tiwary, Krishnan Sunil, Deepa Suresh, Sameep Shetty, Gothandam Kodiveri Muthukaliannan, Siddhartha Baxi, and Rama Jayaraj. 2021. "Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis" Cancers 13, no. 16: 4166. https://doi.org/10.3390/cancers13164166