Prognostic role of neutrophil-to-lymphocyte ratio in diffuse large B cell lymphoma patients: An updated dose-response meta-analysis

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR), a biomarker for systematic inflammation, has been recently identified as a prognostic factor for various types of both solid and hematologic malignancies. Here we conducted an updated dose-response meta-analysis to investigate whether NLR can be served as a prognostic biomarker in diffuse large B cell lymphoma (DLBCL). Methods: We systematically searched PubMed, Embase, ISI Web of Science and CNKI for relevant studies. Odds ratios or hazards ratios (HRs) with corresponding 95% confidence intervals (CIs) were pooled to estimate the association between NLR and clinicopathological parameters or survival of cancer patients. Results: Eleven trials with 2515 DLBCL patients were included in the meta-analysis. The results revealed that elevated pretreatment NLR was significantly associated with elder age, advanced Ann Arbor stage, higher incidence rate of B symptoms and bone marrow involvement, and higher lactate dehydrogenase level, etc. Moreover, increased NLR also predicted poorer overall survival (HR 1.826, 95% CI 1.238-2.692) and progression-free survival/event-free survival (PFS/EFS) (HR 1.591, 95% CI 1.124-2.252). And two-stage dose-response meta-analysis revealed non-linear association between increased NLR and risk of mortality in DLBCL patients. Conclusion: DLBCL patients with higher NLR are more likely to have poorer prognosis than those with lower NLR.