中性粒细胞与淋巴细胞比值在鼻咽癌中的预后价值：截至2026年6月30日30个队列的系统评价与荟萃分析。
Prognostic value of neutrophil-to-lymphocyte ratio in nasopharyngeal carcinoma: a systematic review and meta-analysis of 30 cohorts through June 30, 2026.
文献信息
| PMID | 42870785 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yunliang Lu |
| 作者单位 | Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China. |
| 期刊 | Translational cancer research |
| SCI 分区 | Q3 |
| IF | 1.9 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 既往荟萃分析已将治疗前中性粒细胞与淋巴细胞比值（NLR）升高与鼻咽癌（NPC）的不良结局相关联，但这些分析纳入的近期队列较少，且常将校正与未校正的估计值合并。我们更新了证据基础，并评估了治疗前NLR与生存结局之间关联的一致性和确定性。
方法： 我们系统检索了PubMed、Web of Science、Embase、Cochrane图书馆、中国知网（CNKI）和万方数据，检索时间从建库至2026年6月30日。符合条件的研究为经病理确诊的NPC队列研究，比较治疗前高NLR与低NLR，并报告总生存期（OS）、无进展生存期（PFS）、无远处转移生存期（DMFS）或无局部区域复发生存期（LRFS）的多变量校正风险比（HR）。两名评价者独立筛选研究、提取数据，并使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。采用随机效应模型、预设亚组分析、留一法分析、小样本效应评估以及推荐分级的评估、制定与评价（GRADE）证据确定性评估。
结果： 共纳入30个队列，包含11,671例患者；NOS评分为7至9分。治疗前NLR升高与较差的OS相关[27个队列；HR：2.16，95%置信区间（CI）：1.76-2.66]和PFS相关（18个队列；HR：1.70，95%CI：1.45-2.00）。此外，高NLR与DMFS受损相关（6个队列；HR：1.61，95%CI：1.33-1.93）和LRFS受损相关（2个队列；HR：4.82，95%CI：1.51-15.31）。OS的异质性较大（I2=84%），PFS的异质性中等（I2=57%）。Egger检验提示OS存在漏斗图不对称（P<0.001），但PFS无此现象（P=0.26）。GRADE证据确定性对OS和PFS为极低，对DMFS和LRFS为低。
结论： 治疗前NLR升高与NPC较差的生存结局相关。然而，显著的异质性、OS小样本效应的证据以及低至极低的证据确定性，阻碍了常规临床实施。需要使用标准化采样和截断值方法进行前瞻性验证。
英文摘要
BACKGROUND: Previous meta-analyses have linked an elevated pretreatment neutrophil-to-lymphocyte ratio (NLR) to poor outcomes in nasopharyngeal carcinoma (NPC), but they included few recent cohorts and often combined adjusted and unadjusted estimates. We updated the evidence base and evaluated the consistency and certainty of the associations between pretreatment NLR and survival outcomes.
METHODS: We systematically searched PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data from inception through June 30, 2026. Eligible reports were cohort studies of pathologically confirmed NPC that compared high versus low pretreatment NLR and reported multivariable-adjusted hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), or locoregional recurrence-free survival (LRFS). Two reviewers independently selected studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale (NOS). Random-effects models, prespecified subgroup analyses, leave-one-out analyses, assessment of small-study effects, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty assessment were used.
RESULTS: Thirty cohorts comprising 11,671 patients were included; NOS scores ranged from 7 to 9. Elevated pretreatment NLR was associated with inferior OS [27 cohorts; HR: 2.16, 95% confidence interval (CI): 1.76-2.66] and PFS (18 cohorts; HR: 1.70, 95% CI: 1.45-2.00). Furthermore, high NLR correlated with compromised DMFS (6 cohorts; HR: 1.61, 95% CI: 1.33-1.93) and LRFS (2 cohorts; HR: 4.82, 95% CI: 1.51-15.31). Heterogeneity was substantial for OS (I2=84%) and moderate for PFS (I2=57%). Egger's tests indicated funnel-plot asymmetry for OS (P<0.001), but not PFS (P=0.26). GRADE certainty was very low for OS and PFS and low for DMFS and LRFS.
CONCLUSIONS: Elevated pretreatment NLR was associated with poorer survival outcomes in NPC. However, substantial heterogeneity, evidence of small-study effects for OS, and low to very low certainty of evidence preclude routine clinical implementation. Prospective validation using standardized sampling and cutoff methods is needed.