Affiliations: [a] Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China | [b] Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Correspondence:
[*]
Corresponding author: Weiqiang Yao, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Shanghai 200032, China. Tel.: +86 21 64175590 86627; Fax: +86 21 64173610; E-mail:ysplyy@163.com
Abstract: BACKGROUND:
Systemic inflammation has been implicated in cancer development and
progression. The aim of the present study was to evaluate whether
pre-operative systemic inflammatory markers can predict outcomes in bone and
soft tissue sarcomas. METHODS:
Relevant literature was mainly identified using Pubmed, EMBASE and CNKI.
Patients' clinical characteristics, overall survival (OS), disease/relapse
free survival (DFS/RFS) with high-level CRP or neutrophils to lymphocytes
ratio (NLR) were extracted. The statistics extracted from Kaplan-Meier
survival curves with log-rank p value were calculated with methods developed
by Parmar, Williamson, and Tierney; multivariate Cox hazard regression
analysis data were used directly in STATA 10.0. Pooled hazard ratio (HR) and
95% CI were calculated to evaluate the prognostic role of these systemic
inflammatory markers (CRP/NLR). RESULTS:
After full text review, 11 articles containing 1809 patients were identified
as eligible articles. The meta-analysis for survival outcome showed
significant prognostic value of systemic inflammatory markers including CRP
and NLR in pre-operative blood. The combined HRs (95% CI) for five year
overall survival (OS) and disease/recurrence free survival (DFS/RFS) were
2.54 [2.04, 3.16] and 2.28 [1.72, 3.04]. Specifically, higher NLR was
associated with decreased 5-year OS (HR 3.75, 95% CI 1.24 to 11.37) and 3
year RFS/DFS (HR 2.43, 95% CI 0.84 to 7.05). Besides, the pooled HR showed
a higher risk of 5-year disease progression (HR 2.55, 95% CI 1.60 to
4.08, I2 = 52%) and lower 5-year OS (HR 2.50, 95% CI 2.00 to 3.12,
I2 = 0%) in sarcoma patients with high CRP level. We then grouped the
meta-analysis by patient source (Asian and non-Asian), tumor stage (I/II or
III/IV) and grade (high or low), respectively. All the subgroup analysis
showed significant prognostic role in survival condition. The CRP/NLR levels
are also found closely related with patient age, tumor stage and size. CONCLUSION:
Higher level of pre-operative CRP and NLR demonstrated a significantly
higher risk of recurrence and overall decreased survival rates in sarcomas.
