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中华临床实验室管理电子杂志 ›› 2015, Vol. 03 ›› Issue (03) : 171 -179. doi: 10.3877/cma.j.issn.2095-5820.2015.003.008

所属专题: 专题评论 文献

实验研究

中性粒细胞与淋巴细胞比率评估胃癌预后的Meta分析
卞炳贤, 周韵斓, 沈立松   
  • 收稿日期:2015-07-31 出版日期:2015-08-28
  • 通信作者: 沈立松
  • 基金资助:
    国家自然科学基金资助项目(81372641,81401946)

Prognostic value of neutrophil-lymphocyte ratio in gastric cancer: a meta-analysis

Bingxian Bian, Yunlan Zhou, Lisong Shen   

  • Received:2015-07-31 Published:2015-08-28
  • Corresponding author: Lisong Shen
  • About author:
    Corresponding author: SHEN Lisong, Email:
引用本文:

卞炳贤, 周韵斓, 沈立松. 中性粒细胞与淋巴细胞比率评估胃癌预后的Meta分析[J/OL]. 中华临床实验室管理电子杂志, 2015, 03(03): 171-179.

Bingxian Bian, Yunlan Zhou, Lisong Shen. Prognostic value of neutrophil-lymphocyte ratio in gastric cancer: a meta-analysis[J/OL]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2015, 03(03): 171-179.

目的

分析探讨中性粒细胞与淋巴细胞比率(neutrophil-lymphocyte ratio, NLR)对胃癌患者预后评估的价值。

方法

采用循证医学的meta分析研究。首先,从Embase、Medline和Web of Science数据库中检索关键词gastric cancer、stomach cancer、gastric carcinoma、stomach carcinoma、gastric neoplasm、stomach neoplasm、neutrophil和lymphocyte。然后,根据各纳入研究的总生存率(overall survival, OS)和无进展生存期(progression-free survival, PFS)/无疾病生存期(disease-free survival, DFS)合并生存危险比(hazard ratio, HR)的异质性,决定用固定或随机效应模型计算OS和PFS/DFS的合并HR。若合并HR>1,且其95%可信区间(confidence interval, CI)也>1, 则为NLR升高与胃癌患者OS或PFS/DFS的降低有显著联系。

结果

收集18篇文献共纳入5 065例胃癌患者进行meta分析。升高的NLR与OS降低存在显著关联(HR为1.79,95%CI 1.54~2.08)。亚组分析中,胃癌多种治疗方案组和化疗组NLR升高均与OS降低存在显著关联[HR分别为1.84, (95% CI 1.48~2.29)和1.69, (95% CI 1.41~2.03)];而NLR≤3.2组和NLR>3.2组亦均与OS的降低存在显著关联[HR分别为1.80, (95% CI 1.46~2.23)和1.93, (95% CI 1.58~2.36)]。在胃癌患者OS的单因素meta回归分析中, 发表年份、种族、NLR临界值、治疗方案、患者数、进展期患者比例和男性比例都不是引起胃癌患者异质性来源的可能原因(P值分别为0.585、0.887、0.731、0.697、0.613、0.877、0.775)。

结论

胃癌患者中升高的NLR与OS降低存在显著的关联,NLR可作为评价胃癌患者预后的标志物。

Objective

The neutrophil-lymphocyte ratio (NLR) may indicate the balance of the inflammatory and immune systems, making NLR a useful index to evaluate tumor development. However, its prognostic value in patients with gastric cancer was still unclear. A meta-analysis was performed to characterize the prognostic effect of NLR.

Methods

An extensive literary search for relevant studies was conducted on Embase, Medline and Web of Science databases. The search strategy included the following keywords "gastric cancer", "stomach cancer", "gastric carcinoma", "stomach carcinoma", "gastric neoplasm", "stomach neoplasm", "neutrophil" and "lymphocyte" . Effect measure was hazard ratio (HR) for overall survival (OS) and progression-free survival(PFS) /disease-free survival (DFS). Then pooled HRs and 95% confidence intervals (CIs) were calculated using the random or fixed effect models by the heterogeneity of included studies. The pooled HR and 95% CI >1 indicated elevated NLR was associated with a significantly poorer OS.

Results

This meta-analysis has been based on 18 publications and comprises a total of 5 065 patients with gastric cancer. The pooled HR showed that elevated NLR was associated with a significantly poorer OS (HR 1.79, 95%CI 1.54-2.08). Subgroup analysis showed the prognostic effect of NLR was identical in multiple treatment methods subgroup and chemotherapy subgroup[HR 1.84, (95% CI 1.48-2.29) and 1.69, (95% CI 1.41-2.03), respectively]. The same effect was also seen in NLR≤3.2 subgroup and NLR>3.2 subgroup [HR 1.80, (95% CI 1.46-2.23) and 1.93, (95% CI 1.58-2.36), respectively]. At univariate meta-regression analysis in OS, the results indicated publication year, ethnicity, NLR cutoff value, treatment type, sample size, proportion of patients in advanced stage and proportion of male did not contribute to the cause of heterogeneity(P value of 0.585, 0.887, 0.731, 0.697, 0.613, 0.877, 0.775).

Conclusion

The overall findings of this study support the hypothesis that elevated NLR is associated with a significantly poorer OS and NLR could be a prognostic marker in gastric cancer.

图1 文献检索及选择图
表1 纳入文献的基本特征
表2 胃癌患者病情主要结果
图2 总体生存率的meta分析森林图
图3 亚洲国家亚组和白种人国家亚组OS的meta分析森林图
图4 多种治疗方案亚组和化疗亚组总体OS的meta分析森林图
图5 NLR≤3.2亚组和NLR>3.2亚组总体OS的meta分析森林图
图6 胃癌患者NLR与DFS/PFS的meta分析森林图
表3 胃癌患者OS单因素meta回归分析
图7 胃癌患者总体OS的Begg’s漏斗图
图8 胃癌患者总体OS敏感性的Meta分析图
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