Neutrophil–lymphocyte ratio is a predictor of prognosis in patients with castration-resistant prostate cancer: a meta-analysis

Figures & data

Figure 1 Flow diagram of the study selection process.

Abbreviation: CRPC, castration-resistant prostate cancer.

Table 1 Main characteristics of the included studies

Authors	Year	Duration	Country	No. of patients	Median age (range) (years)	Treatment	Median follow-up (months)	NLR(+) No. (%)	NLR cutoff value	Survival analysis
Linton et al^Citation29	2013		Australia	182	NA	Docetaxel	NA	104 (56.5%)	≥5	OS
Nuhn et al^Citation21	2014	1998-2010	Germany	238	68.3 (44.6-84.5)	Docetaxel	15.0 (1.5-90.2)	168 (70%)	>3	OS
Sonpavde et al^Citation37	2014	2008-2010	USA	848	68 (NA)	Docetaxel	NA	NA	>3.4	OS
Sümbül et al^Citation33	2014	2009-2013	Turkey	33	71.24* (NA)	Docetaxel	NA	18(54.6%)	>3	PFS
Templeton et al^Citation38	2014	2001-2011	Canada	357	71 (44-90)	Docetaxel	NA	260 (73%)	>3	OS
Lorente et al^Citation19	2015	NA	UK	755	67 (62-73)	Docetaxel or mitoxantrone	NA	NA	>3	OS
McLachlan et al^Citation31	2015	2005-2012	Australia	42	(50-84)	Docetaxel or Cabazitaxel	NA	14(33.3%)	≥5	OS. PFS
van Soest et al^Citation32	2015	NA	The Netherlands	1,224	68 (40-88)	VENICE (Docetaxel)	NA	NA	≥2	OS
				1,006	68 (36-92)	TAX327 (D3+ Docetaxel)	NA	NA	≥2.1	OS
Yao et al^Citation30	2015	2009-2014	Japan	57	74.0 (55-91)	Docetaxel	19.0(1-61)	27 (47.4%)	≥3.5	OS. PFS
Conteduca et al^Citation34	2016	2012-2014	Italy	193	73.1 (42.8-90.7)	Enzalutamide	10.4 (NA)	105 (54.4%)	>3	OS. PFS
Lolli et al^Citation39	2016	2011-2015	Italy	230	74 (45-90)	Abiraterone	29 (1-55)	104 (45.2%)	≥3	OS
Boegemann et al^Citation22	2017	NA	Germany	96	70 (NA)	Abiraterone	22 (NA)	17(17.7%)	>5	OS. PFS
Buttigliero et al^Citation36	2017	2004-2016	Italy	110	68 (48-85)	Docetaxel	31.7 (NA)	64 (58%)	>3	OS. PFS
Mehra et al^Citation23	2017	NA	UK	75	NA	Prednisolone or dexamethasone	NA	NA	≥2.6	OS
Pei et al^Citation35	2017	2009-2016	China	111	71(43-86)	Docetaxel	16 (1-50)	42 (37.8%)	>3.3	OS. PFS
Uemura et al^Citation24	2017	2014-2016	Japan	47	NA	Cabazitaxel	NA	20 (42.6%)	≥3.83	OS

Note:

* mean age.

Abbreviations: NA, not available; NLR, neutrophil–lymphocyte ratio; OS, overall survival; PFS, progression-free survival.

Table 2 NLR pooled HRs and 95% CIs in meta-analysis for OS and PFS

Stratified analysis	OS								Begg’s test P-value	PFS								Begg’s test P-value
	No. of studies	Chi-squared	Pheterogeneity	I^Citation2(%)	Pooled HR (95% CI)					No. of studies	Chi-squared	Pheterogeneity	I^Citation2 (%)	HR (95% CI)
					Fixed effect	P-value	Random effect	P-value						Fixed effect	P-value	Random effect	P-value
Overall
	16	23.7	0.07	37.7	1.52 (1.41–1.63)	<0.001	1.59 (1.42–1.77)	<0.001	0.096	7	5.29	0.507	0	1.50 (1.21–1.85)	<0.001	1.50 (1.21–1.85)	<0.001	0.23
Nation
Asian	3	0.43	0.807	0	2.43 (1.47–4.01)	0.001	2.43 (1.47–4.01)	0.001		2	0.31	0.577	0	1.99 (1.30–3.06)	0.002	1.99 (1.30–3.06)	0.002
Non- Asian	13	19.82	0.071	39.5	1.50 (1.40–1.62)	<0.001	1.56 (1.39–1.74)	<0.001		5	2.72	0.606	0	1.36 (1.07–1.74)	0.014	1.36 (1.07–1.74)	0.014
Treatment
First selected	13	16.97	0.151	29.3	1.49 (1.38–1.60)	<0.001	1.53 (1.38–1.70)	<0.001		5	5.14	0.273	22.2	1.51 (1.17–1.95)	0.002	1.55 (1.14–2.10)	0.005
Second selected	3	2.8	0.247	28.5	1.97 (1.51–2.57)	<0.001	1.92 (1.37–2.69)	<0.001		2	0.14	0.706	0	1.48 (1.01–2.17)	0.046	1.48 (1.01–2.17)	0.046
No. of patients
<182	7	1.04	0.984	0	2.16 (1.66–2.80)	<0.001	2.16 (1.66–2.80)	<0.001		6	5.18	0.394	3.4	1.52 (1.20–1.93)	<0.001	1.53 (1.20–1.94)	0.001
≥182	9	15.15	0.056	47.2	1.47 (1/37–1.59)	<0.001	1.50 (1.34–1.69)	<0.001		1	–	–	–	1.38 (0.82–2.32)	0.225	1.38 (0.82–2.32)	0.225
Cutoff
>3.3	7	10.68	0.099	43.8	1.58 (1.38–1.82)	<0.001	1.72 (1.32–2.25)	<0.001		4	0.73	0.867	0	1.87 (1.38–2.54)	<0.001	1.87 (1.38–2.54)	<0.001
≤3.3	9	12.52	0.13	36.1	1.49 (1.37–1.63)	<0.001	1.56 (1.38–1.76)	<0.001		3	0.41	0.814	0	1.20 (0.89–1.62)	0.233	1.20 (0.89–1.62)	0.233

Abbreviations: NLR, neutrophil–lymphocyte ratio; OS, overall survival; PFS, progression-free survival.

Figure 2 Forest plot HR for the correlation between neutrophil–lymphocyte ratio and overall survival (A) and progression-free survival (B) in castration-resistant prostate cancer patients.

Figure 3 Subgroup analysis of pooled overall survival based on a neutrophil–lymphocyte ratio cutoff value (A), nation (B), treatment (C), and number of patients (D).

Figure 4 Subgroup analysis of pooled progression-free survival based on neutrophil–lymphocyte ratio cutoff value (A), nation (B), treatment (C), and number of patients (D).

Figure 5 Funnel plots based on overall survival (A) and progression-free survival (B) (Begg’s test).

Abbreviation: SE, standard error.

Figure 6 Sensitivity analysis for overall survival (A) and progression-free survival (B) in this meta-analysis.

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