Papakonstantinou M, Fiflis S, Christodoulidis G, Giglio MC, Louri E, Mavromatidis S, Giakoustidis D, Papadopoulos VN, Giakoustidis A. Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review. World J Clin Oncol 2022; 13(10): 822-834 [PMID: 36337307 DOI: 10.5306/wjco.v13.i10.822]
Corresponding Author of This Article
Gregory Christodoulidis, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Menelaos Papakonstantinou, Stylianos Fiflis, Eleni Louri, Savvas Mavromatidis, Dimitrios Giakoustidis, Vasileios N Papadopoulos, Alexandros Giakoustidis, Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
Gregory Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Mariano Cesare Giglio, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples 80138, Italy
Author contributions: Papakonstantinou M and Fiflis S contributed equally to this work and wrote most of the manuscript; Papakonstantinou M, Fiflis S and Giakoustidis A designed the research study, performed the research and analyzed the data; Christodoulidis G offered guidance and assisted as a corresponding author; Giglio M offered guidance and performed manuscript revisions; Louri E and Mavromatidis S assisted in writing part of the introduction and performed manuscript revisions; Giakoustidis D and Papadopoulos VN assisted in writing part of the discussion and performed manuscript revisions; Giakoustidis A perceived the idea and assisted as a supervising author; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gregory Christodoulidis, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: April 26, 2022 Peer-review started: April 26, 2022 First decision: June 22, 2022 Revised: July 8, 2022 Accepted: October 11, 2022 Article in press: October 11, 2022 Published online: October 24, 2022
ARTICLE HIGHLIGHTS
Research background
Patients with CRLM can be treated surgically or non-surgically, but regardless of the medical intervention they have low overall survival and disease-free survival.
Research motivation
It is important to develop prognostic biomarkers that could predict survival, tumor recurrence and response to treatment in order for patients to benefit most from medical interventions and receive personalized treatment.
Research objectives
To identify all possible articles related to our topic and examine the use of NLR as a prognostic factor in CRLM patients in clinical practice. We aimed to demonstrate that NLR is a possible significant biomarker that could assist in the management of CRLM patients by predicting survival, tumor recurrence or response to treatment.
Research methods
We performed an extensive search of PubMed, the Cochrane Library and also searched for unpublished articles in “clinicaltrials.gov”. We used combinations of the words “Neutrophil to Lymphocyte ratio”, “NLR”, “survival”, “prognostic factor”, “metastasis”, “metastases”, “liver metastasis”, “liver metastases”. The results were screened by two independent researchers and any potential differences were resolved between them and a third researcher through discussion. The aim was to identify studies that investigated the correlation between NLR and survival or tumor recurrence in CRLM patients.
Research results
We included 19 studies that included CRLM patients who were treated with different medical approaches, surgically or non-surgically. All the studies demonstrated that high NLR was associated with poor survival, disease-free survival and response to chemotherapy.
Research conclusions
The NLR could potentially be used as a predictor of survival, tumor recurrence and chemosensitivity in CRLM patients.
Research perspectives
Prospective, well-structured studies are needed in order to examine the role of the neutrophil to lymphocyte ratio (NLR) as a prognostic factor and establish it as part of the decision-making tools of clinicians in the management of colorectal liver metastasis (CRLM) patients.
