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Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Prognostic value of systemic inflammatory markers in ovarian Cancer: a PRISMA-compliant meta-analysis and systematic review

Authors: Ying Zhu, Sanqin Zhou, Yang Liu, Lingyun Zhai, Xiwen Sun

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

The prognostic effect of elevated systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), remains controversial in cancer patients. This meta-analysis was conducted to evaluate the predictive values of these markers for prognoses in ovarian cancer patients.

Methods

Potentially relevant publications in PubMed, ISI Web of Science, and EBSCO were searched. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for overall survival (OS) and progression-free survival (PFS) were determined using a fixed or random effects model.

Results

Ten studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse OS (HR = 1.34, 95% CI = 1.16-1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17-1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61-2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46-2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.

Conclusion

This comprehensive meta-analysis suggested that the values of inflammatory markers such as NLR and PLR were associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.
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Literature
1.
2.
go back to reference Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Primers. 2016;2:16061.CrossRefPubMed Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Primers. 2016;2:16061.CrossRefPubMed
3.
go back to reference Auer KB-HA, Sukhbaatar N, Aust S, Schmetterer KG, Meier SM, Gerner C, Grimm C, Horvat R, Pils D. Role of the immune system in the peritoneal tumor spread of high grade serous ovarian cancer. Oncotarget. 2016;7(38):61336–54.CrossRefPubMedPubMedCentral Auer KB-HA, Sukhbaatar N, Aust S, Schmetterer KG, Meier SM, Gerner C, Grimm C, Horvat R, Pils D. Role of the immune system in the peritoneal tumor spread of high grade serous ovarian cancer. Oncotarget. 2016;7(38):61336–54.CrossRefPubMedPubMedCentral
4.
go back to reference Orditura M, Galizia G, Diana A, Saccone C, Cobellis L, Ventriglia J, Iovino F, Romano C, Morgillo F, Mosca L, Diadema MR, Lieto E, Procaccini E, De Vita F, Ciardiello F. Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis. ESMO Open. 2016;1(2):e000038.CrossRefPubMedPubMedCentral Orditura M, Galizia G, Diana A, Saccone C, Cobellis L, Ventriglia J, Iovino F, Romano C, Morgillo F, Mosca L, Diadema MR, Lieto E, Procaccini E, De Vita F, Ciardiello F. Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis. ESMO Open. 2016;1(2):e000038.CrossRefPubMedPubMedCentral
5.
go back to reference Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.CrossRefPubMed Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.CrossRefPubMed
7.
go back to reference Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, Uchida E. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal Cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2015;23(2):646–54.CrossRefPubMed Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, Uchida E. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal Cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2015;23(2):646–54.CrossRefPubMed
8.
go back to reference Sun B, Tang L, Li X, Wang B, Luo G, Gu L, Chen L, Liu K, Gao Y, Zhang X. Prognostic value of neutrophil-to-lymphocyte ratio in localized and advanced prostate Cancer: a systematic review and meta-analysis. PLoS One. 2016;11(4):e0153981.CrossRef Sun B, Tang L, Li X, Wang B, Luo G, Gu L, Chen L, Liu K, Gao Y, Zhang X. Prognostic value of neutrophil-to-lymphocyte ratio in localized and advanced prostate Cancer: a systematic review and meta-analysis. PLoS One. 2016;11(4):e0153981.CrossRef
9.
go back to reference Woo HD, Kim K, Kim J. Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis. Cancer Causes Control. 2015;26(11):1661–70.CrossRefPubMed Woo HD, Kim K, Kim J. Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis. Cancer Causes Control. 2015;26(11):1661–70.CrossRefPubMed
10.
go back to reference Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemotherapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomarkers. 2016;17(1):33–40.CrossRefPubMed Miao Y, Yan Q, Li S, Li B, Feng Y. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are predictive of chemotherapeutic response and prognosis in epithelial ovarian cancer patients treated with platinum-based chemotherapy. Cancer Biomarkers. 2016;17(1):33–40.CrossRefPubMed
11.
go back to reference Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23(4):265.CrossRefPubMedPubMedCentral Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23(4):265.CrossRefPubMedPubMedCentral
12.
go back to reference Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):2046–4053. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):2046–4053.
13.
go back to reference Wang Y, Liu P, Xu Y, Zhang W, Tong L, Guo Z, Ni H. Preoperative neutrophil-to-lymphocyte ratio predicts response to first-line platinum-based chemotherapy and prognosis in serous ovarian cancer. Cancer Chemother Pharmacol. 2014;75(2):255–62.CrossRefPubMed Wang Y, Liu P, Xu Y, Zhang W, Tong L, Guo Z, Ni H. Preoperative neutrophil-to-lymphocyte ratio predicts response to first-line platinum-based chemotherapy and prognosis in serous ovarian cancer. Cancer Chemother Pharmacol. 2014;75(2):255–62.CrossRefPubMed
14.
go back to reference Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, Lee K. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2008;58(1):15–23.CrossRefPubMed Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, Lee K. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2008;58(1):15–23.CrossRefPubMed
15.
go back to reference Wang YQ, Jin C, Zheng HM, Zhou K, Shi BB, Zhang Q, Zheng FY, Lin F. A novel prognostic inflammation score predicts outcomes in patients with ovarian cancer. Clin Chim Acta. 2016;456:163–9.CrossRefPubMed Wang YQ, Jin C, Zheng HM, Zhou K, Shi BB, Zhang Q, Zheng FY, Lin F. A novel prognostic inflammation score predicts outcomes in patients with ovarian cancer. Clin Chim Acta. 2016;456:163–9.CrossRefPubMed
16.
go back to reference Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol. 2011;13(7):499–503.CrossRefPubMed Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol. 2011;13(7):499–503.CrossRefPubMed
17.
go back to reference Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, Cramer DW. Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecol Oncol. 2014;132(3):542–50.CrossRefPubMedPubMedCentral Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, Cramer DW. Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecol Oncol. 2014;132(3):542–50.CrossRefPubMedPubMedCentral
18.
go back to reference Thavaramara T, Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer. J Med Assoc Thail. 2011;94(7):871–7. Thavaramara T, Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer. J Med Assoc Thail. 2011;94(7):871–7.
19.
go back to reference Feng Z, Wen H, Bi R, Ju X, Chen X, Yang W, Wu X. Preoperative neutrophil-to-lymphocyte ratio as a predictive and prognostic factor for high-grade serous ovarian Cancer. PLoS One. 2016;11(5):e0156101.CrossRefPubMedPubMedCentral Feng Z, Wen H, Bi R, Ju X, Chen X, Yang W, Wu X. Preoperative neutrophil-to-lymphocyte ratio as a predictive and prognostic factor for high-grade serous ovarian Cancer. PLoS One. 2016;11(5):e0156101.CrossRefPubMedPubMedCentral
20.
go back to reference Zhang W-w, Liu K-j, Hu G-l, Liang W-j. Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients. Tumor Biol. 2015;36(11):8831–7.CrossRef Zhang W-w, Liu K-j, Hu G-l, Liang W-j. Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients. Tumor Biol. 2015;36(11):8831–7.CrossRef
21.
go back to reference Li Z, Hong N, Robertson M, Wang C, Jiang G. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer. Sci Rep. 2017;7:43001.CrossRefPubMedPubMedCentral Li Z, Hong N, Robertson M, Wang C, Jiang G. Preoperative red cell distribution width and neutrophil-to-lymphocyte ratio predict survival in patients with epithelial ovarian cancer. Sci Rep. 2017;7:43001.CrossRefPubMedPubMedCentral
22.
go back to reference Chen Y, Chen K, Xiao X, Nie Y, Qu S, Gong C, Su F, Song E. Pretreatment neutrophil-to-lymphocyte ratio is correlated with response to neoadjuvant chemotherapy as an independent prognostic indicator in breast cancer patients: a retrospective study. BMC Cancer. 2016;16(1):320.CrossRefPubMedPubMedCentral Chen Y, Chen K, Xiao X, Nie Y, Qu S, Gong C, Su F, Song E. Pretreatment neutrophil-to-lymphocyte ratio is correlated with response to neoadjuvant chemotherapy as an independent prognostic indicator in breast cancer patients: a retrospective study. BMC Cancer. 2016;16(1):320.CrossRefPubMedPubMedCentral
23.
go back to reference Na N, Yao J, Cheng C, Huang Z, Hong L, Li H, Qiu J. Meta-analysis of the efficacy of the pretreatment neutrophil-to-lymphocyte ratio as a predictor of prognosis in renal carcinoma patients receiving tyrosine kinase inhibitors. Oncotarget. 2016;7(28):44039–46.CrossRefPubMedPubMedCentral Na N, Yao J, Cheng C, Huang Z, Hong L, Li H, Qiu J. Meta-analysis of the efficacy of the pretreatment neutrophil-to-lymphocyte ratio as a predictor of prognosis in renal carcinoma patients receiving tyrosine kinase inhibitors. Oncotarget. 2016;7(28):44039–46.CrossRefPubMedPubMedCentral
24.
go back to reference Gemenetzis GBF, Griffin JF, Rezaee N, Javed AA, Manos LL, Lennon AM, Wood LD, Hruban RH, Zheng L, Zaheer A, Fishman EK, Ahuja N, Cameron JL, Weiss MJ, He J, Wolfgang CL. Neutrophil-to-lymphocyte ratio is a predictive marker for invasive malignancy in Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2017;266(2):339-45. Gemenetzis GBF, Griffin JF, Rezaee N, Javed AA, Manos LL, Lennon AM, Wood LD, Hruban RH, Zheng L, Zaheer A, Fishman EK, Ahuja N, Cameron JL, Weiss MJ, He J, Wolfgang CL. Neutrophil-to-lymphocyte ratio is a predictive marker for invasive malignancy in Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2017;266(2):339-45.
25.
go back to reference Wu Y, Li C, Zhao J, Yang L, Liu F, Zheng H, Wang Z, Xu Y. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict chemotherapy outcomes and prognosis in patients with colorectal cancer and synchronous liver metastasis. World J Surg Oncol. 2016;14(1):289.CrossRefPubMedPubMedCentral Wu Y, Li C, Zhao J, Yang L, Liu F, Zheng H, Wang Z, Xu Y. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict chemotherapy outcomes and prognosis in patients with colorectal cancer and synchronous liver metastasis. World J Surg Oncol. 2016;14(1):289.CrossRefPubMedPubMedCentral
26.
go back to reference Lafrenie RM, Asano Y, Kashiwagi S, Onoda N, Noda S, Kawajiri H, Takashima T, Ohsawa M, Kitagawa S, Hirakawa K. Platelet–lymphocyte ratio as a useful predictor of the therapeutic effect of neoadjuvant chemotherapy in breast Cancer. PLoS One. 2016;11(7):e0153459.CrossRef Lafrenie RM, Asano Y, Kashiwagi S, Onoda N, Noda S, Kawajiri H, Takashima T, Ohsawa M, Kitagawa S, Hirakawa K. Platelet–lymphocyte ratio as a useful predictor of the therapeutic effect of neoadjuvant chemotherapy in breast Cancer. PLoS One. 2016;11(7):e0153459.CrossRef
Metadata
Title
Prognostic value of systemic inflammatory markers in ovarian Cancer: a PRISMA-compliant meta-analysis and systematic review
Authors
Ying Zhu
Sanqin Zhou
Yang Liu
Lingyun Zhai
Xiwen Sun
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4318-5

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