NLR a strong predictor of survival in cholangiocarcinoma

Pre-treatment neutrophil-to-lymphocyte ratio (NLR) values appear to be correlated with overall survival (OS) and disease-free survival (DFS) in patients with cholangiocarcinoma (CCA), reports a recent meta-analysis.

The analysis included 32 eligible studies, contributing a total of 8,572 patients. Participants had mean age ranging from 56 to 70 years, with men comprising 31 percent to 79 percent of the study samples. Applying the Newcastle-Ottawa scale revealed scores ranging from six to nine points, suggestive of generally good quality overall. All eligible studies were retrospective in nature.

Pooled analysis of 19 studies revealed that NLR was a significant and independent correlate of OS, such that high values before treatment increased the risk of death by nearly 30 percent (hazard ratio [HR], 1.28, 95 percent confidence interval [CI], 1.18–1.38; p<0.01). Heterogeneity of evidence was high (p<0.01).

Similarly, high NLR worsened DFS by nearly 40 percent (HR, 1.39, 95 percent CI, 1.17–1.66; p<0.01), with high heterogeneity (p=0.02).

Principal findings were robust to subgroup analyses, which showed that the impact of NLR on survival outcomes was unaffected by treatment modality, patient age, study sample size, or prespecified NLR cut-off values.

“As patients undergoing surgery for CCA display high rates of perioperative morbidity and mortality, preoperative patient selection is fundamental to balance surgical risk with oncological benefits. Here, NLR provides additional information for treatment selection and risk stratification,” the researchers said.