■这项系统综述和荟萃分析检查了淋巴细胞与单核细胞比率(LMR)是否可以作为预测可切除胰腺癌患者预后的指标。
■这项荟萃分析在PROSPERO:CRD42023461260注册。在PubMed进行了系统的文献检索,Embase,科克伦,和截至2023年9月的WebofScience数据库,以评估LMR是否可以预测可切除胰腺癌患者的预后。测量的结果包括总生存期(OS)的亚组分析,风险比(HR)和地理区域的置信区间,患者群体,和LMR阈值。还对OS和HR进行了敏感性分析,并计算了无复发生存期(RFS)的置信区间。
■共有14篇合格文章,包括4,019名患者,纳入综合分析。综合分析的结果表明,LMR是操作系统的可靠预测指标,表现出较强的预后意义(HR=0.55,95%CI[0.44-0.69],I2=79%,P<0.00001)。这种预测意义延伸到各种类型的胰腺癌,如胰腺导管腺癌(HR=0.73,95%CI[0.57-0.93],I2=46%,P=0.01),胰腺神经内分泌肿瘤(HR=0.81,95%CI[0.66-0.99],P=0.04)和其他亚型(HR=0.40,95%CI[0.22-0.72],I2=89%,P<0.00001),但不适用于胰头癌(HR=0.46,95%CI[0.16-1.13],I2=59%,P=0.12)。LMR在不同地区保留了其预测价值,包括亚洲(HR=0.62,95%CI[0.47-0.76],I2=68%,P<0.0001),欧洲(HR=0.78,95%CI[0.67-0.91],I2=0%,P=0.002),和美洲(HR=0.14,95%CI[0.08-0.24],I2=0%,P<0.00001)。值得注意的是,两个LMR截止值都大于或等于3(HR=0.62,95%CI[0.47-0.82],I2=67%,P=0.0009)和小于3(HR=0.47,95%CI[0.32-0.69],I2=85%,P=0.0001)表现出预后意义。对OS的敏感性分析证实了LMR的强预测值,而LMR对RFS没有预测意义(HR=0.35,95%CI[0.09-1.32],I2=95%,P=0.12)。在根据纽卡斯尔-渥太华量表(NOS)评分≥7(HR=0.66,95%CI[0.54-0.80],I2=53%,P=0.04)和<7(HR=0.41,CI[0.23-0.72],I2=89%,P<0.00001),LMR被证明具有预测价值。
■尽管在纳入的研究中观察到异质性和潜在偏见,这项研究的结果表明,LMR可能是可切除胰腺癌患者OS的一个有价值的预测指标。
UNASSIGNED: This systematic
review and meta-analysis examined whether the lymphocyte-to-monocyte ratio (LMR) can serve as an indicator for predicting the prognosis of patients with resectable pancreatic cancer.
UNASSIGNED: This meta-analysis was registered with PROSPERO: CRD42023461260. A systematic literature search was conducted in the PubMed, Embase, Cochrane, and Web of Science databases up to September 2023 to assess whether LMR can predict the prognosis of patients with resectable pancreatic cancer. The outcomes measured included subgroup analyses of overall survival (OS) with hazard ratios (HR) and confidence intervals of geographical region, patient population, and LMR threshold. A sensitivity analysis was also performed for OS and HR and confidence intervals were calculated for recurrence-free survival (RFS).
UNASSIGNED: A total of 14 eligible articles, comprising 4,019 patients, were included in the comprehensive analysis. The results of this comprehensive analysis indicate that LMR is a robust predictor of OS, demonstrating strong prognostic significance (HR = 0.55, 95% CI [0.44-0.69], I2 = 79%, P < 0.00001). This predictive significance extended to various types of pancreatic cancer, such as pancreatic ductal adenocarcinoma (HR = 0.73, 95% CI [0.57-0.93], I2 = 46%, P = 0.01), pancreatic neuroendocrine neoplasms (HR = 0.81, 95% CI [0.66-0.99], P = 0.04) and other subtypes (HR = 0.40, 95% CI [0.22-0.72], I2 = 89%, P < 0.00001), but not to pancreatic head cancer (HR = 0.46, 95% CI [0.16-1.13], I2 = 59%, P = 0.12). LMR retained its predictive value across different regions, including Asia (HR = 0.62, 95% CI [0.47-0.76], I2 = 68%, P < 0.0001), Europe (HR = 0.78, 95% CI [0.67-0.91], I2 = 0%, P = 0.002), and the Americas (HR = 0.14, 95% CI [0.08-0.24], I2 = 0%, P < 0.00001). Notably, both LMR cut-off values greater than or equal to three (HR = 0.62, 95% CI [0.47-0.82], I2 = 67%, P = 0.0009) and less than three (HR = 0.47, 95% CI [0.32-0.69], I2 = 85%, P = 0.0001) exhibited prognostic significance. The sensitivity analysis for OS confirmed the strong predictive value of LMR, whereas LMR did not exhibit predictive significance for RFS (HR = 0.35, 95% CI [0.09-1.32], I2 = 95%, P = 0.12). In both subgroups categorized by Newcastle-Ottawa Scale (NOS) scores of ≥7 (HR = 0.66, 95% CI [0.54-0.80], I2 = 53%, P = 0.04) and <7 (HR = 0.41, CI [0.23-0.72], I2 = 89%, P < 0.00001), LMR was demonstrated to have predictive value.
UNASSIGNED: Despite the observed heterogeneity and potential biases in the included studies, the findings of this study suggest that LMR may serve as a valuable predictor of OS in patients with resectable pancreatic cancer.