Abstract 64P
Background
Gallbladder cancer is a rare malignancy characterized by poor survival outcomes and lack of durable response to current treatment options. Majority of patients are diagnosed at an advanced stage or with distant metastasis upon presentation. As such, the prognosis of patients with gallbladder cancer is dismal, with 5-year survival rates of 15-20% and median survival time of 2 to 4 months in those with advanced stage. Cellular-mediated inflammatory response has been shown to play a key role in tumor growth and development. Moreover, inflammatory markers are valuable prognostic biomarkers in cancer. In lieu of this finding, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) have been utilized as prognostic markers in various types of malignancies. Their role in the prognostication of gallbladder cancer remains debatable with no consensus on their effect on survival. This systematic review and meta-analysis sought to examine the prognostic role of NLR, PLR and MLR on the survival of patients with gallbladder cancer.
Methods
A systematic search was conducted to examine the prognostic significance of NLR, PLR and MLR on the prognosis of gallbladder cancer. Systematic search was done using Pubmed, Cochraine and Google Scholar for articles published until January 1, 2020. Hazard ratios (HRs) with 95% confidence intervals (95% CI) were pooled from the included studies. The primary outcome of interest was overall survival. Data was summarized using RevMan 5.3.
Results
Ten studies with a total of 2, 246 patients were included in the analysis. High NLR (HR 1.83 95% CI 1.42- 2.36, p<0.00001, I2 65%), PLR (HR 1.41 95% CI 1.15-1.74, p=0.0009, I2 46%), and MLR (HR 1.95 95% CI 1.61-2.36, I2 10% p=<0.00001) were associated with worse survival. Due to significant heterogeneity among studies investigating NLR, a sensitivity analysis was conducted which excluded two studies, and still showed consistent prognostic value (HR 1.75 95% CI 1.47- 2.07, p < 0.00001, I2 8%).
Conclusions
NLR, PLR and MLR are promising cost-effective inflammatory biomarkers for worse survival in gallbladder cancer which the clinician can use in treatment planning, monitoring and prognostication.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.