A Review of the Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Nonhematologic Malignancies

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2024 Sep 28

PMID 39335736

Authors

Defne Cigdem Koc

Ion Bogdan Manescu

Mariuca Manescu

Minodora Dobreanu

Affiliations

Soon will be listed here.

Abstract

Biomarkers are crucial in cancer diagnostics, prognosis, and surveillance. Extensive research has been dedicated to identifying biomarkers that are broadly applicable across multiple cancer types and can be easily obtained from routine investigations such as blood cell counts. One such biomarker, the neutrophil-to-lymphocyte ratio (NLR), has been established as a prognostic marker in cancer. However, due to the dynamic nature of cancer diagnosis and treatment, periodic updates are necessary to keep abreast of the vast amount of published data. In this review, we searched the PubMed database and analyzed and synthesized recent literature (2018-February 2024) on the role of NLR in predicting clinical outcomes in nonhematologic malignancies. The search was conducted using the PubMed database. We included a total of 88 studies, encompassing 28,050 human subjects, and categorized the findings into four major groups: gastrointestinal cancer, cancers of the urinary tract and reproductive system, lung cancer, and breast cancer. Our analysis confirms that NLR is a reliable prognostic indicator in cancer, and we discuss the specific characteristics, limitations, and exceptions associated with its use. The review concludes with a concise Q&A section, presenting the most relevant take-home messages in response to five key practical questions on this topic.

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References

Etani T, Naiki T, Sugiyama Y, Nagai T, Iida K, Noda Y . Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis. Oncology. 2020; 98(12):876-883. DOI: 10.1159/000508923. View

Munoz-Montano W, Cabrera-Galeana P, Alvarado-Miranda A, Villarreal-Garza C, Mohar A, Olvera A . Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio in Different Phenotypes of Locally Advanced Breast Cancer During Neoadjuvant Systemic Treatment. Clin Breast Cancer. 2020; 20(4):307-316.e1. DOI: 10.1016/j.clbc.2019.12.011. View

Wu Y, Jiang M, Qin Y, Lin F, Lai M . Single and combined use of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and carcinoembryonic antigen in diagnosing gastric cancer. Clin Chim Acta. 2018; 481:20-24. DOI: 10.1016/j.cca.2018.02.027. View

Templeton A, McNamara M, Seruga B, Vera-Badillo F, Aneja P, Ocana A . Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6):dju124. DOI: 10.1093/jnci/dju124. View

Wang H, Huang X, Chen J, Li Y, Cong Y, Qu B . Long-term efficacy and predictors of pembrolizumab-based regimens in patients with advanced esophageal cancer in the real world. World J Gastroenterol. 2023; 29(41):5641-5656. PMC: 10701330. DOI: 10.3748/wjg.v29.i41.5641. View

Forget P, Khalifa C, Defour J, Latinne D, Van Pel M, De Kock M . What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes. 2017; 10(1):12. PMC: 5217256. DOI: 10.1186/s13104-016-2335-5. View

Cui X, Zhu S, Tao Z, Deng X, Wang Y, Gao Y . Long-term outcomes and prognostic markers in gallbladder cancer. Medicine (Baltimore). 2018; 97(28):e11396. PMC: 6076111. DOI: 10.1097/MD.0000000000011396. View

Chen T, Song C, Liang G, Xu X, Wang C, Zhang Z . Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Their Variations as a Basis for a Prediction Model in Advanced NSCLC Patients Receiving Anlotinib. Dis Markers. 2022; 2022:5879137. PMC: 8958089. DOI: 10.1155/2022/5879137. View

Bizzarri N, DIndinosante M, Marchetti C, Tudisco R, Turchiano F, Scambia G . The prognostic role of systemic inflammatory markers in apparent early-stage ovarian cancer. Int J Clin Oncol. 2022; 28(2):314-320. PMC: 9889507. DOI: 10.1007/s10147-022-02272-z. View

10.

Cousillas Castineiras A, Gallardo Martin E, Fernandez Montes A, Campos M, Covela Rua M, Salgado Fernandez M . Dynamic perspective of the neutrophil-to-lymphocyte ratio in metastatic gastric cancer. J BUON. 2021; 26(5):2131-2140. View

11.

Song H, Jeong M, Cha J, Lee J, Yoo J, Song M . Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer. Int J Med Sci. 2021; 18(16):3712-3717. PMC: 8579283. DOI: 10.7150/ijms.64658. View

12.

Peng H, Yang L, He B, Pan Y, Ying H, Sun H . Combination of preoperative NLR, PLR and CEA could increase the diagnostic efficacy for I-III stage CRC. J Clin Lab Anal. 2016; 31(5). PMC: 6816914. DOI: 10.1002/jcla.22075. View

13.

Tsilimigras D, Moris D, Mehta R, Paredes A, Sahara K, Guglielmi A . The systemic immune-inflammation index predicts prognosis in intrahepatic cholangiocarcinoma: an international multi-institutional analysis. HPB (Oxford). 2020; 22(12):1667-1674. DOI: 10.1016/j.hpb.2020.03.011. View

14.

Lee A, Lee H, Huang H, Tay K, Lee L, Sim S . Prognostic Significance of Inflammation-associated Blood Cell Markers in Nonmetastatic Clear Cell Renal Cell Carcinoma. Clin Genitourin Cancer. 2020; 18(4):304-313. DOI: 10.1016/j.clgc.2019.11.013. View

15.

Dudani S, Marginean H, Tang P, Monzon J, Raissouni S, Asmis T . Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictive and prognostic markers in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation. BMC Cancer. 2019; 19(1):664. PMC: 6612202. DOI: 10.1186/s12885-019-5892-x. View

16.

Borella F, Bertero L, Valabrega G, Fucina S, Cassoni P, Benedetto C . Searching for prognostic markers for Stage I epithelial ovarian cancer: A role for systemic inflammatory markers. Int J Gynaecol Obstet. 2023; 164(1):262-269. DOI: 10.1002/ijgo.15014. View

17.

Vernieri C, Mennitto A, Prisciandaro M, Huber V, Milano M, Rinaldi L . The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict efficacy of platinum-based chemotherapy in patients with metastatic triple negative breast cancer. Sci Rep. 2018; 8(1):8703. PMC: 5992181. DOI: 10.1038/s41598-018-27075-z. View

18.

Howard R, Scheiner A, Kanetsky P, Egan K . Sociodemographic and lifestyle factors associated with the neutrophil-to-lymphocyte ratio. Ann Epidemiol. 2019; 38:11-21.e6. PMC: 8653546. DOI: 10.1016/j.annepidem.2019.07.015. View

19.

Wu L, Zou S, Wang C, Tan X, Yu M . Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in Chinese Han population from Chaoshan region in South China. BMC Cardiovasc Disord. 2019; 19(1):125. PMC: 6537433. DOI: 10.1186/s12872-019-1110-7. View

20.

Ba Y, Shi Y, Jiang W, Feng J, Cheng Y, Xiao L . Current management of chemotherapy-induced neutropenia in adults: key points and new challenges: Committee of Neoplastic Supportive-Care (CONS), China Anti-Cancer Association Committee of Clinical Chemotherapy, China Anti-Cancer Association. Cancer Biol Med. 2020; 17(4):896-909. PMC: 7721096. DOI: 10.20892/j.issn.2095-3941.2020.0069. View