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©The Author(s) 2022.
World J Clin Oncol. Oct 24, 2022; 13(10): 822-834
Published online Oct 24, 2022. doi: 10.5306/wjco.v13.i10.822
Published online Oct 24, 2022. doi: 10.5306/wjco.v13.i10.822
Ref. | Number of patients | Sex | Mean age (years) | NLR threshold | Follow up (mo), mean (range) | Sample acquisition |
Erstad et al[13] | 151 | 84 M, 67 F | 58 | 5 | 41.3 ± 36.7 (2-186) | Within 6 mo prior to surgery and prior to chemotherapy |
Halazun et al[14] | 440 | 289 M, 151 F | 64 (32-88) | 5 | 24 (11-97) | 1 d prior to surgery |
Kishi et al[15] | 290 | Resection group 132 M, 68 F; non resection group 61 M, 29 F | Resection, 57; non resection, 56 | 5 | 28 (2-102) | Resection group: Before chemotherapy and before resection |
Neal et al[16] | 302 | 192 M, 110 F | 64.8 (26-85) | 5 | 29.5 (4-96) | Prior to surgery |
Hand et al[17] | 322 | 205 M, 117 F | 252 p < 70 yr; 70 p > 70 yr | 5 | 41 | On admission; the night prior to or on the morning of surgery |
Peng et al[18] | 150 | 97 M, 53 F | 58 (20-82) | 4.63 | 36 (2-126) | Within 7 d prior to surgery |
Kim et al[19] | 83 | 62 M, 21 F | 59.5 | 1.94 | NS | Within 1 wk prior to surgery |
Mao et al[20] | 183 | 123 M, 60 F | 67 p > 60 yr | 2.3 | 36.3 | Within 10 d before chemotherapy and surgery |
Neofytou et al[21] | 140 | 88 M, 52 F | 78% < 70 yr | 2.4 | 33 (1-103) | Within 10 d prior to surgery |
Giakoustidis et al[22] | 169 | 104 Μ, 65 F | 135 p < 70 yr, 34 p > 40 yr | 2.5 | 34.6 | 10 d prior to surgery - after preoperative chemotherapy |
Dupré et al[23] | 343 | 236 M, 107 F | 65.8 ± 10.9 | 2.5, 2.6 and 7.261 | 49 | Within 1 wk prior to surgery |
Hamada et al[24] | 29 | 20 M, 9 F | 63 ± 11.6 (41-83) | 4.1 | 51 (2-97) | NS |
Zeman et al[25] | 130 | 70 M, 60 F | 60 (33-82) | 5 | 39.3 | NS |
Ref. | Median Survival | 5-year OS | 5-year DFS | Extrahepatic Disease | Primary Tumor | Chemotherapy |
Erstad et al[13] | 3.1 yr, NLR > 5; 6.3 yr NLR < 5 | 28.7%, NLR > 5; 59.6%, NLR < 5 | NS | Νο | Previous resection of rectum or colon | Neoadjuvant |
Halazun et al[14] | NS | 22%, NLR > 5; 43%, NLR < 5 | 12%, NLR > 5; 42%, NLR < 5 | No disseminated or unresectable EHD | Previously resected | Neoadjuvant |
Kishi et al[15] | 34 mo, NLR > 5; 45 mo, NLR < 5 | 26%, NLR > 5; 36%, NLR < 5 | NS | No | Previously resected | Neoadjuvant, n = 200; Without resection, n = 90 |
Neal et al[16] | 27.8 mo, NLR > 5; 39.8 mo, NLR < 5 | 18.5% NLR > 5; 30.6% NLR < 5 | 22.3%, NLR > 5; 35.2%, NLR < 52 | NS | Rectum n = 149, Colon n = 153 | Adjuvant, n = 126 |
Hand et al[17] | 59 mo | Chemotherapy group, 50.8%; No chemotherapy group, 42.5% | NS | NS | No | Neoadjuvant, n = 202 |
Peng et al[18] | NS | 18.8%, NLR > 4.63; 46.7%, NLR < 4.63 | NS | No | 58% colon, 42% rectum | Neoadjuvant, n = 59 |
Kim et al[19] | NS | NS | NS | No | NS | Neoadjuvant, n = 24 |
Mao et al[20] | 31.1 mo NLR > 2.3 43.1 mo NLR < 2.3 | NS | NS | No | Colon n = 104 | Neoadjuvant, n = 183 |
Neofytou et al[21] | 55 mo, NLR > 2.4; Not reached, NLR < 2.4 | 42%, NLR > 2.4; 69%, NLR < 2.4 | Total 27%. 14%, NLR > 2.4; 40%, NLR < 2.4 | Νο | Resection prior to hepatectomy in 81% | Neoadjuvant |
Giakoustidis et al[22] | 75 mo | 51%, NLR > 2.5; 74% NLR < 2.5 | NS | No | Synchronous resection, n = 26; ‘liver first’, n = 7 | Neoadjuvant, n = 169 |
Dupré et al[23] | 50.3, NLR < 2.5; 38.4, NLR > 2.5; 44.8, NLR < 7.26; 25.4, NLR > 7.26 | NS | 11.6, NLR < 2.5; 9.7, NLR > 2.5; 10.3, NLR < 7.26; 6.3, NLR > 7.261 | Resectable EHD in 36 patients | Synchronous, n = 169; Right colon, n = 73; Left colon, n = 126; Rectum, n = 142; Multiple, n = 2 | Neoadjuvant, n = 198 |
Hamada et al[24] | NS | NS | NS | Yes, n = 5 | NS | Adjuvant, n = 15 |
Zeman et al[25] | Resection group, 56 mo | 46.6%, resection group; 9.5%, RFA group | 30.5%, resection group, 21 mo median | No | Rectum n = 60, colon n = 70 | Adjuvant, n = 25 |
Ref. | Univariate analysis | Multivariate analysis |
Erstad et al[13] | NLR > 5 was significantly associated with reduced OS (P = 0.001) | NLR > 5 associated with reduced OS (P = 0.032) |
Halazun et al[14] | NLR > 5 was associated with reduced OS (P < 0.0001); NLR > 5 was the sole positive predictor of recurrence (P < 0.0001) | NLR > 5 was associated with reduced OS (P < 0.0001) |
Kishi et al[15] | NLR > 5 predicted worse survival (P = 0.011) | NLR > 5 predicted worse survival using variables available before surgery (P = 0.016) and after surgery (P = 0.048) |
Neal et al[16] | NLR > 5 was significantly associated with worse OS (P = 0.001) and CSS (P < 0.001) following metastasectomy | NLR > 3 was associated with shorter survival (P < 0.001); NLR > 3 was associated with adverse outcomes regarding CSS (P < 0.001) |
Hand et al[17] | Following index hepatectomy, patients with NLR > 5 had a median survival of 55 mo vs 70 mo when NLR < 5 (P = 0.027); Following neoadjuvant chemotherapy, no association between NLR and survival was demonstrated (P = 0.93); NLR > 5 had no impact on prognosis following repeat hepatectomy | There is an independent association between elevated preoperative neutrophil count and shortened overall survival (P = 0.001); no such association was found for NLR |
Peng et al[18] | Patients with NLR > 4.63 were more likely to present multiple hepatic metastases than those with low NLR (68.8% vs 40.3%, P = 0.030); 5-year RFS and OS for high NLR were significantly inferior to those for low NLR (RFS: 12.5% vs 38.5%, P = 0.015; OS: 18.8% vs 46.7%, P = 0.004) | NLR was not identified as an independent inflammatory factor for better RFS |
Kim et al[19] | NLR > 1.94 was a prognostic factor for poor OS (P = 0.035) and DFS; High NLR was associated with recurrence (P = 0.031) | NLR > 1.94 was an independent prognostic factor for OS (P = 0.01) and prognostic factor for poor DFS; High NLR was associated with recurrence (P = 0.006) |
Mao et al[20] | Pre- and post-chemotherapy NLR > 2.3 was associated with decreased OS (P = 0.012) | NLR > 2.3 was a significant predictor both for worse OS (P < 0.001) and for RFS (P = 0.017) |
Neofytou et al[21] | NLR > 2.4 was associated with decreased DFS (P = 0.033) and OS (P = 0.007) | No significant correlation was found between NLR and OS/DFS |
Giakoustidis et al[22] | NLR > 2.5 was associated with decreased OS (P = 0.009) and decreased DFS (P = 0.09) | High NLR remained a significant prognostic factor for poor OS (P = 0.012) |
Dupré et al[23] | NLR of 2.5 was an independent prognostic factor for OS and PFS | High NLR was significantly associated with decreased OS (P < 0.002) |
Hamada et al[24] | NLR > 4.1 was significantly correlated with better CSS (P = 0.026) | Only univariate analysis was performed |
Zeman et al[25] | NLR > 5 was significantly associated with DFS (P = 0.044); OS was significantly affected by the preoperative number of leukocytes (P = 0.0014) and neutrophils (P = 0.0036) but not by the NLR. | NLR > 5 was significantly associated with DFS (P = 0.03); Leukocyte number was significantly associated with OS (P = 0.0014); no effect of NLR was demonstrated on OS |
Ref. | Number of patients and procedure | Sex | Mean age (yr) | NLR threshold | Follow up (mo) | Sample acquisition |
Tohme et al[29] | 104 RE | 69 M, 35 F | 60.8 ± 12.2, NLR > 5, 66.4 ± 12.2, NLR < 5 | 5 | 100 patients died during follow up | Same day before RE |
Chang et al[26] | 98 RFA | 56 M, 42 F | 62 (28-92) | 2.5 | 35.2 ± 21.89 | 1 d before RFA - 1 mo after RFA |
Zhang et al[27] | 92 RFA | 51 M, 41 F | 59 (43-78) | 5 | 27.1 ± 9.8 (range 5-62) | Preoperatively as part of the routine workup. 1-3 d before RFA |
Weiner et al[28] | 131 RE | 84 M, 47 F | 59 | 5 | 117 deaths during follow up | NS |
Kishi et al[15] | 90 chemotherapy | 61 M, 29 F | 56 | 5 | 28 (2-102) | |
Wu et al[31] | 55 chemotherapy | 35 M, 20 F | 59 | 4 | Complete clinical records (no exact mention) | Preoperatively and before 2nd cycle of chemotherapy |
Philips et al[30] | 71 | - | - | 5 | - | - |
Ref. | Median Survival | 5-year OS | 5-year DFS | Extrahepatic disease | Primary tumor | Chemotherapy |
Tohme et al[29] | 5.6 m high NLR 10.6 m low NLR | - | - | 40 (less than 10% of tumor burden) | Some patients had undergone CRC resection (number not mentioned) | All patients |
Chang et al[26] | - | - | (Preoperative NLR) 11.1% high NLR 22.6% low NLR (NLR increase after RFA 8.6%) (No postoperative NLR increase 22.2%) | No | All patients had undergone CRC resection | No mention |
Zhang et al[27] | - | 18,4% high NLR 41.7% low NLR | 9.5% high NLR 26.7% low NLR | No | All patients had undergone CRC resection | If necessary after primary tumor resection (number not mentioned) |
Weiner et al[28] | 7.9 m high NLR 13 low NLR | - | - | 59 | 79% had undergone primary CRC resection | All patients |
Kishi et al[15] | 11 m high NLR 21 m low NLR | 0% high NLR 14% low NLR | - | No | All patients had undergone CRC resection | All patients |
Wu et al[31] | 24 m high NLR 56 m low NLR | - | - | No | All patients had undergone CRC resection | All patients |
Philips et al[30] | 14.7 m high NLR 31.9 m low NLR | - | - | Liver dominant disease | Not mentioned | All patients |
Ref. | Univariate analysis | Multivariate analysis |
Tohme et al[29] | High NLR associated with decreased OS P < 0.001 | High NLR associated with decreased OS (HR = 1.927, 95%CI: 1.202-3.089, P = 0.006) |
Chang et al[26] | Preoperative high NLR and postoperative increase in NLR were associated with decreased DFS (P = 0.044 and P = 0.022, respectively) | Only postoperative NLR increase was associated with decreased DFS (P = 0.029) |
Zhang et al[27] | High NLR associated with decreased OS (P = 0.007) and DFS (P = 0.007) | High NLR associated with decreased OS (P = 0.039, HR = 3.59, 95%CI: 1.54-9.67) and DFS (P = 0.022, HR = 3.19, 95%CI: 1.87-8.24). |
Weiner et al[28] | High NLR associated with decreased OS (HR = 2.18, 95%CI: 1.45-3.28, P = 0.0002) | High NLR associated with decreased OS (HR = 2.22, 95%CI: 1.46-3.38, P = 0.0002) |
Kishi et al[15] | High NLR associated with decreased OS (HR = 3.1, 95%CI: 1.7-5.9, P < 0.001) | High NLR associated with decreased OS (HR = 2.9, 95%CI: 1.5-5.5, P = 0.001). |
Wu et al[31] | High NLR (HR = 3.182, 95%CI: 1.277-7.933, P = 0.013) associated with decreased OS and DFS (HR = 2.284, 95%CI: 1.156-4.498, P = 0.017). Patients with normalization of NLR had better DFS than those with high NLR that did not decrease (P = 0.002). | No association between NLR and survival |
Philips et al[30] | High NLR associated with decreased OS P = 0.067 (statistically significant) | No association between NLR and survival |
- Citation: Papakonstantinou M, Fiflis S, Christodoulidis G, Giglio MC, Louri E, Mavromatidis S, Giakoustidis D, Papadopoulos VN, Giakoustidis A. Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review. World J Clin Oncol 2022; 13(10): 822-834
- URL: https://www.wjgnet.com/2218-4333/full/v13/i10/822.htm
- DOI: https://dx.doi.org/10.5306/wjco.v13.i10.822