High Neutrophil-to-Lymphocyte Ratio Is Associated With Poorer Survival in Solid Tumors Overall and in Individual Cancer Types
In a systematic review and meta-analysis reported in Journal of the National Cancer Institute, Templeton et al found that high neutrophil-to-lymphocyte ratio, a marker of inflammation, is associated with significantly poorer overall survival in solid tumors overall and by individual category. High neutrophil-to-lymphocyte ratio was also associated with significantly poorer cancer-specific survival, progression-free survival, and disease-free survival.
The meta-analyses included 100 studies (57 published in 2012 or later) comprising 40,559 patients. The median cutoff for high neutrophil-to-lymphocyte ratio was 4.
Worse Overall Survival
Overall, neutrophil-to-lymphocyte ratio greater than the cutoff was associated with a hazard ratio (HR) for overall survival of 1.81 (P < .001) for all tumors. Hazard ratios for overall survival were significant for all tumor types examined, including 2.35 (95% confidence interval [CI] = 1.89–2.92) for mesothelioma, 2.27 (95% CI = 1.01–5.14) for pancreatic cancer, 2.22 (95% CI = 1.72–2.88) for renal cell carcinoma, 1.91 (95% CI = 1.53–2.39) for colorectal cancer, 1.66 (95% CI = 1.46–1.88) for gastroesophageal cancer, 1.66 (95% CI = 1.40–1.96) for non–small cell lung cancer, 1.43 (95% CI = 1.25–1.63) for cholangiocarcinoma, 1.43 (95% CI = 1.23–1.66) for hepatocellular carcinoma, and 1.71 (95% CI = 1.52–1.92) for other unselected solid tumors.
Differences between disease subgroups were significant (P = .001 for subgroup difference). The hazard ratios for overall survival for neutrophil-to-lymphocyte ratio above the cutoff were also significant for all nonmetastatic tumors (1.57, 95% CI = 1.36–1.82) and all metastatic tumors (1.80, 95% CI = 1.63–1.99).
Among all tumors, hazard ratios for neutrophil-to-lymphocyte ratio above the cutoff were 1.61 for cancer-specific survival, 1.63 for progression-free survival, and 2.27 for disease-free survival (all P < .001).
The investigators concluded, “A high [neutrophil-to-lymphocyte ratio] is associated with an adverse [overall survival] in many solid tumors. The [neutrophil-to-lymphocyte ratio] is a readily available and inexpensive biomarker, and its addition to established prognostic scores for clinical decision making warrants further investigation.”
Eitan Amir, MD, PhD, Princess Margaret Cancer Centre, Toronto, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by a grant from the Swiss Cancer Research Foundation.
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