Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review

doi:10.5306/wjco.v13.i10.822

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World Journal of Clinical Oncology

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World J Clin Oncol. Oct 24, 2022; 13(10): 822-834
Published online Oct 24, 2022. doi: 10.5306/wjco.v13.i10.822

Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review

Menelaos Papakonstantinou, Stylianos Fiflis, Gregory Christodoulidis, Mariano Cesare Giglio, Eleni Louri, Savvas Mavromatidis, Dimitrios Giakoustidis, Vasileios N Papadopoulos, Alexandros Giakoustidis

Menelaos Papakonstantinou, Stylianos Fiflis, Eleni Louri, Savvas Mavromatidis, Dimitrios Giakoustidis, Vasileios N Papadopoulos, Alexandros Giakoustidis, Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece

Gregory Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece

Mariano Cesare Giglio, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples 80138, Italy

Author contributions: Papakonstantinou M and Fiflis S contributed equally to this work and wrote most of the manuscript; Papakonstantinou M, Fiflis S and Giakoustidis A designed the research study, performed the research and analyzed the data; Christodoulidis G offered guidance and assisted as a corresponding author; Giglio M offered guidance and performed manuscript revisions; Louri E and Mavromatidis S assisted in writing part of the introduction and performed manuscript revisions; Giakoustidis D and Papadopoulos VN assisted in writing part of the discussion and performed manuscript revisions; Giakoustidis A perceived the idea and assisted as a supervising author; all authors have read and approved the final manuscript.

Conflict-of-interest statement: All authors report no relevant conflict 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.

Corresponding author: Gregory Christodoulidis, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr

Received: April 26, 2022
Peer-review started: April 26, 2022
First decision: June 22, 2022
Revised: July 8, 2022
Accepted: October 11, 2022
Article in press: October 11, 2022
Published online: October 24, 2022
Processing time: 176 Days and 12.5 Hours

ARTICLE HIGHLIGHTS

Research background

Patients with CRLM can be treated surgically or non-surgically, but regardless of the medical intervention they have low overall survival and disease-free survival.

Research motivation

It is important to develop prognostic biomarkers that could predict survival, tumor recurrence and response to treatment in order for patients to benefit most from medical interventions and receive personalized treatment.

Research objectives

To identify all possible articles related to our topic and examine the use of NLR as a prognostic factor in CRLM patients in clinical practice. We aimed to demonstrate that NLR is a possible significant biomarker that could assist in the management of CRLM patients by predicting survival, tumor recurrence or response to treatment.

Research methods

We performed an extensive search of PubMed, the Cochrane Library and also searched for unpublished articles in “clinicaltrials.gov”. We used combinations of the words “Neutrophil to Lymphocyte ratio”, “NLR”, “survival”, “prognostic factor”, “metastasis”, “metastases”, “liver metastasis”, “liver metastases”. The results were screened by two independent researchers and any potential differences were resolved between them and a third researcher through discussion. The aim was to identify studies that investigated the correlation between NLR and survival or tumor recurrence in CRLM patients.

Research results

We included 19 studies that included CRLM patients who were treated with different medical approaches, surgically or non-surgically. All the studies demonstrated that high NLR was associated with poor survival, disease-free survival and response to chemotherapy.

Research conclusions

The NLR could potentially be used as a predictor of survival, tumor recurrence and chemosensitivity in CRLM patients.

Research perspectives

Prospective, well-structured studies are needed in order to examine the role of the neutrophil to lymphocyte ratio (NLR) as a prognostic factor and establish it as part of the decision-making tools of clinicians in the management of colorectal liver metastasis (CRLM) patients.