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Authors Zhou Y, Li D, Lin Y, Yu M, Lu X, Jian Z, Na N, Hou B
Received 27 September 2017
Accepted for publication 18 February 2018
Published 1 May 2018 Volume 2018:11 Pages 2489—2496
DOI https://doi.org/10.2147/OTT.S152657
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 5
Editor who approved publication: Prof. Dr. Geoffrey Pietersz
Background: Systemic inflammation can be reflected by peripheral hematologic
parameters and combined index like the lymphocyte count, neutrophil count,
platelet count, neutrophil-to-lymphocyte (NLR), and platelet-to-lymphocyte
ratio (PLR). This systematic review and meta-analysis aimed to summarize the
association between the hematologic markers and prognosis of
gastroenteropancreatic neuroendocrine tumors (GEP–NETs).
Methods: A computerized systematic search of PubMed, Embase, and Web of
Science was conducted up to August 2016. Studies evaluating prognosis value of
hematologic parameters in patients with GEP–NETs were retrieved. For
meta-analysis, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were
extracted and synthesized using Review Manager software.
Results: We identified eight retrospective cohort studies comprising a total of
724 cases. The majority of included studies focused on pancreatic
neuroendocrine tumors (PNETs). The prognostic values of NLR, PLR, and platelet
count were reported in six studies, two studies, and one study, respectively.
All the parameters were associated with prognostic outcomes in patients with
GEP–NETs. A high NLR was significantly associated with poor prognosis in
GEP–NETs (pooled HR 3.05, 95% CI 1.96–4.76, I 2 = 0%, P < 0.00001 for
overall survival (OS); pooled HR 3.30, 95% CI 2.04–5.32, I 2 = 0%, P < 0.00001
for recurrence-free survival [RFS]). In PNETs, pooled-analyses also showed
significant superiority of a low NLR on OS (pooled HR 4.21, 95% CI
1.95–9.13, I 2 = 0%, P = 0.0003)
and RFS (pooled HR 5.37, 95% CI 2.14–13.47, I 2 = 0%, P = 0.003).
Conclusions: These findings suggest that the elevated NLR could be an adverse
prognosis factor for GEP–NETs. The conclusion should be mainly limited to PNETs
as the majority of included cases were PNET patients. The prognostic value of
other hematologic parameters deserves further investigation. We recommend that
further studies should use a continuous NLR variable and adopt a prospective
and matched study design.
Keywords: neuroendocrine tumor, blood cell, lymphocyte, neutrophil, platelet,
prognosis