ASPO Abstracts
Heterogeneity in the prognostic value of the neutrophil-to-lymphocyte ratio: a meta-analysis and independent cohort study.
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
Purpose of studyWe evaluate whether the prognostic potential of the neutrophil-to-lymphocyte ratio, an established marker of systemic inflammation associated with survival outcomes in cancer patients, differs between patient subgroups.MethodsA meta-analysis of 228 published studies and a retrospective cohort of 5,363 patients treated at the Moffitt Cancer Center in Tampa, FL are coupled to investigate sources of heterogeneity in the association between pre-treatment NLR and survival. We define demographically and clinically homogeneous patient subgroups based on study-level and individual-level variables, and identify patients for whom the NLR has maximum prognostic potential.Results In the Moffitt cohort, NLR demonstrated stronger associations (HRs>2) with survival among African-American patients, patients receiving only radiation therapy, stage IV patients and patients with melanoma than in the overall study population (HR=1.58). Sensitivity and specificity of the NLR as a prognostic marker were also higher in these and other patient subgroups than for the population as a whole, and increased further still for patients with a combination of multiple “high-risk” demographic or clinical characteristics. While significant heterogeneity was observed between studies in the meta-analysis, increased effect sizes in melanoma patients and radiation-treated patients were also observed in the published literature.ConclusionsThe NLR has greater prognostic value in patients with certain demographic and clinical features. Association studies with arbitrary high-risk cutoffs in small, homogeneous populations may be of limited value. Future work should focus on further characterization of populations with maximum prognostic potential and identifying clinically meaningful thresholds for risk stratification.
Keywords: neutrophil-to-lymphocyte ratio, inflammation, survival