Neutrophil-to-lymphocyte ratio and survival outcomes in testicular cancer: A systematic review and meta-analysis

Abstract

Introducción : El cáncer testicular es la neoplasia maligna sólida más común en pacientes jóvenes entre 15 y 44 años , con tendencia al alza durante la última década. Objetivo : Evaluar los valores del índice Neutrófilo-Linfocito (INL) en la supervivencia de pacientes diagnosticados con cáncer testicular. Materiales y Métodos : Metanálisis de modelo de efectos aleatorios evaluando la supervivencia general y la supervivencia libre de progresión , cumpliendo 6 estudios con los criterios de inclusión. Resultados : Se incluyeron 6 estudios , de los cuales se obtuvo una población total de 1315 . Se evaluó los niveles altos del INL , los cuales se asociaron a una menor supervivencia general (HR: 1.75;IC del 95%: 1,04 - 2,92, I2 : 65%). Conclusión : Se encontró asociación entre niveles elevados de INL y menor supervivencia general , a pesar de esto se determinó que este resultado presenta sesgo de publicación, presentando falta de asociación en este resultado.

Background: The neutrophil-to-lymphocyte ratio (NLR) is a biomarker in inflammatory processes associated with multiple unfavorable outcomes in various diseases. This study aims to evaluate the association between NLR values and survival outcomes in patients diagnosed with testicular cancer.Methods: A systematic search was conducted in 6 electronic databases to retrieve studies evaluatingNLR in patients with testicular cancer. The outcomes sought were overall survival (OS) and progression-free survival (PFS),and the effect measures were hazard ratio (HR) with a 95% confidence interval (CI). A random effects model was used for the meta-analysis. The risk of bias included in thestudies was assessed according to the Newcastle–Ottawa Scale criteria. Egger test and Trim-and-fill method were used to test the publication bias among articles.Results: Six cohort studies (n= 1315) were evaluated. High NLR values are associated with a higher risk of OS (HR: 1.75;95% CI 1.04 –2.92, I2: 65%). However, no statistically significant association was found between NLR and PFS values. We found publication bias in the association between NLR and OS (Eggertest < 0.1). This bias was corrected by using the trim-and-fill method (HR: 1.38, 95% CI 0.85 –2.22)Conclusions: High NLR values are associated with worse OS; however, this result had publication bias, and the association was lost when this bias was corrected. Furthermore, no statistically significant association was found between NLR values and PFS.