Background
Materials and methods
Data sources and search strings
Inclusion and exclusion criteria
Data extraction and quality assessment
Statistical analyses
Results
Study selection
Study description and quality assessment
Author Year Country | Inclusion period | Study design N Age, median (range) | Clinical stage | Treatment | Female (%) | Current/ever smoker (%) | ECOG PS < 2 (%) | Inflammation score and cut-offs applied | Median follow-up, months (range) | Overall survival U/M HR (95% CI) or log-rank p value | Adjustment variables | Quality Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Bernhardt 2008 Germany [16] | 1999–2017 | Retrospective N = 350 Median: 64 years (37–93) | LD: 350 (100) | Concurrent TCR: 350 (100) | 137 (39) | NR | Median KPS: 80 (50–100) | NLR: 2.65 and 4.0 | NR | U: 2.65: 0.86 (0.64–1.15) 4.0: 0.92 (0.71–1.19) | Low quality | |
Cao 2017 China [48] | January 2008–January 2010 | Retrospective N = 707 Mean: 56 ± 10.15 years | LD: 419 (59) ED: 288 (41) | Platinum and etoposide: 707 (100) Thoracic RT: 294 (42) | 253 (36) | 442 (63) | KPS: > 80 point 543 (77) ≤ 80 points 164 (23) | NLR: 3.18a PLR: 176.5a LMR: 2.615a | 562 (79%) events during follow-up | U: PLR not significant NLR p = 0.002 LMR p = 0.008 M: NLR: 1.030 (0.837–1.267) LMR: 1.053 (0.848-1.307) | Age, sex, KPS, smoking history, anaemia, lymphocyte count, NLR, PLR, LMR, LDH, ALP, surgery, thoracic irradiation, number of chemo cycles, number of metastatic sites, stage | Moderate quality |
Deng 2017 China [21] | March 2007–December 2014 | Retrospective N = 320 Median: 58 years (24–81) | LD: 122 (38) ED: 198 (62) | Surgery: 27 (8) Thoracic RT: 135 (42) PCI: 77 (24) | 81 (25) | 215 (63) | 0: 104 (33) ≥ 1: 216 (67) | NLR: 2.65a PLR: 125a | 39.1 (3.2–85.4) | U: NLR < 0.001 PLR = 0.099 M: NLR: 1.35 (1.02–1.79) | NR | Low quality |
Gioulbasanisb 2012 Greece [22] | February 2006–March 2008 | Retrospective N = 96 (SCLC N = 46) Median: 63 years (32–83) | NR | Platinum-based doublet CT: 96 (100) | 12 (13) | NR | 66 (69) | mGPS: 0/1/2 | NR | U: SCLC: p = 0.008 M: no data for SCLC alone | Low quality | |
He 2015 China [23] | June 2006–December 2011 | Retrospective N = 365 Median: 59 years (22–82) | LD: 201 (55) ED: 164 (45) | Etoposide-based CT: 191 (52) Irinotecan-based CT: 171 (47) Thoracic RT: 139 (38) PCI: 86 (24) | 55 (15) | 291 (80) | 338 (93) | ALI: 19.5a | Last follow-up date September 2014 | M: 1.617 (1.160 2.254) | Clinical stage, PS and LDH | Moderate quality |
Hong 2015 [24] China | January 2000–December 2012 | Retrospective N = 919 Median: 56 years (16–84) | LD: 552 (60) ED: 367 (40) | Surgery, RT, CT: 760 (83) No treatment: 159 (17) | 284 (30) | 567 (62) | 760 (83) | NLR: 5 PLR: 250 SII: 1600 | Last follow up data December 2014 | U: NLR: p = 0.007 PLR: p = 0.004 SII: p < 0.001 M: NLR: 0.908 (0.721–1.144) PLR: 0.975 (0.783–1.215) SII: 1.377 (1.024–1.852) | Sex, age, smoking history, PS, stage, BMI, response to treatment, platelet count, HGB, MCV, MPV, PNI, LDH | Low quality |
Kang 2014 Korea [25] | July 2006–October 2013 | Retrospective N = 187 Median: 68 years (43–84) | LD: 67 (36) ED: 120 (64) | Platinum-based CT | 25 (13) | 172 (92) | 163 (87) | NLR: 4a PLR: 160a | 40.28 (2.60–89.26) | U: NLR: p = 0.019 PLR: p = 0.467 M: NLR: 1.465 (1.012–2.119) PLR: 0.896 (0.628–1.280) | Stage and LDH | Moderate quality |
Käsmann 2017 Germany [26] | 2006–2014 | Retrospective N = 65 ≤ 65 years: 36 (55%) > 65 years: 29 (45%) | LD: 65 (100) | Concurrent TCR: 35 (54) PCI: 47 (72) | 25 (38) | 18 (28) | 47 (72) | NLR: 4 PLR: 180 | NR | U: NLR: p = 0.001 PLR: non-significant M: NLR: 2.05 (1.06–3.95) | PS, pathologic lymph node, smoking, and PCI | Low quality |
Kim 2016 Korea [27] | January 2010–October 2015 | Retrospective N = 186 Mean: 69 years ± 9.4 | LD: 64 (34) ED: 122 (66) | CT: 94 (50) TRC: 59 (32) Chest RT: 2 (1) Supportive care only 31 (17) | 30 (16) | 166 (89) | 132 (71) | ALI: 31.1a | 29.0 (19.7–38.3) 141 (83.5%) events during follow up | U: 2.10 (1.50–2.94) M: 1.67 (1.17–2.37) | NR | Low quality |
Kim 2019 Korea [28] | 2010–2016 | Retrospective N = 157 Mean: 66 years ± 9.0 | LD: 67 (43) ED: 90 (57) | NR | 29 (19) | NR | NR | NLR: 2.48a PLR: 110.43a | NR | U: Low NLR vs high NLR: 27.6 months vs 19.3 months, p = 0.151 Low PLR vs high PLR: 31.1 vs 19.3 months, p = 0.155 | Low quality | |
Kurishima 2017 Japan [29] | April 1999–July 2016 | Retrospective N = 319 Median: 71 years (49–94) | LD: 103 (32) ED: 216 (68) | CT: 276 (87) Supportive care: 43 (13) | 46 (14) | 304 (95) | 192 (78) (PS 0–2) | mGPS: 0/1/2 | NR | M: Score 1 vs 0: 1.23 (0.86–1.74) (N = 54) Score 2 vs 0: 2.04 C1.51–2.78) (N = 73) | NR | Low quality |
Liu 2017 China [30] | January 2009–October 2013 | Retrospective N = 139 Mean: 58 years ± 10.5 | LD: 55 (39) ED: 83 (60) NR: 1 (1) | CT: 120 (86) RT: 61 (44) | 32 (23) | 100 (72) | NR | NLR:4.55a PLR:148a | NR Follow up for at least 12 months | U: NLR: 3.309 (2.088–5.244) PLR: 1.813 (1.200–2.738) M: NLR: 2.093 (1.079–4.063) PLR: not significant, p = 0.332 | Stage, metastatic disease, liver metastasis, adrenal metastasis, RT, CT, RBC, HGB, albumin, LDH | Low quality |
Lohinai 2019 Hungary/Italy/Russia [31] | 1999–2013, 3 centres | Retrospective N = 155 Median: 58 years (Range NR) | I: 60 II: 29 III: 40 Unknown: 26 | Surgery, adjuvant CT: 100 (65) | 41 (26) | 141 (91) | NR | NLR: 2.258a PLR: 111.253a | NR Last follow up date: April 2017 | U: NLR: 1.621 (1.036–2.537) Low PLR vs. high PLR, median OS, 73.6 vs. 40.4 months, respectively, p = 0.084 M: NLR: 1.582 (1.010–2.478) | Surgery, pathologic lymph node, stage | Moderate quality |
Minami 2017 Japan [32] | November 2007–June 2016 | Retrospective N = 97 Mean: 71 years ± 8.7 | IIIB: 18 (19) IV:79 (81) | Platinum-based CT: 97 (100) palliative RT: 4 (4) | 20 (21) | 67 (69) | 66 (68) | mGPS: 0/1/2 | NR 78 (80%) events during follow up | mGPS 0, 1 vs 2 U: 1.92 (1.19–3.07) M: 2.34 (1.27–4.31) | Brain metastasis, liver metastasis, bone metastasis, adrenal metastasis, PS, BMI, haemoglobin, creatinine clearence, sodium, LDH, ALP, CRP | High quality |
Mirili 2018 Turkey | May 2007–February 2017 | Retrospective N = 112 Median: 58 years (38–83) | LD: 26 (23) ED: 86 (77) | TCR: 35 (31) Platinum-based doublet CT: 62 (55) No treatment: 15 (13) | 20 (18) | 106 (95) | 69 (62) | NLR: 3 / 4 | 8.4 (0.03–69.8) 89 (79.5%) events during follow-up | M: beta coef: 0.151 SE = 0.077 | Whole body total lesion glycolysis, age, sex, stage | Low quality |
Pan 2019 China [33] | January 2014–May 2016 | Retrospective N = 73 Mean: 62 years (39–83) | LD: 29 (40) ED: 37 (51) Unknown: 7 (9) | Etoposide/carboplatin: 18 (25) etoposide/cisplatin: 40 (55) Other CT: 15 (21) local RT: 34 (47) | 4 (6) | 44/66 (67) | 34/66 (52) | NLR: 3.8a | NR Last follow-up date: August 31, 2017 60 (82%) events during follow-up | U: high-NLR (n = 26) vs low-NLR groups (n = 34): 13.73 ± 1.87 vs. 13.22 ± 2.18 months; P = 0.785 | Low quality | |
Sakin 2019 Turkey [34] | 2012–2018 | Retrospective. N = 113 Median: 61 years (35–83) | ED 113 (100) | Platinum/etoposide: 98 (87) Etoposide: 6 (1) Best supportive care: 9 (1) | 21 (19) | 113 (100) | 72 (64) | NLR:3.0a PLR: 150a MLR:0.367a | 6 (1–33) 92 (81%) events during follow-up | U: NLR: 2.23 (1.42–3.32) PLR: 1.69 (1.08–2.26) MLR: 0.61 (0.40–0.94) M: NLR: 2.26 (1.25–4.10) PLR and MLR: NR | NR | Low quality |
Sakin 2019 Turkey [34] | 1997–2017 | Retrospective. N = 90 Median: 59 years (42–83) | LD: 90 (100) | Platinum/etoposide: 90 (100) | 18 (20) | 86 (96) | PS: 0–2: 77 (86) | NLR:3.0a PLR: 150a MLR:0.367a | NR 53 (59%) events during follow-up | U: NLR: 0.98 (0.89–1.08) PLR: 1.0 (0.99–1.00) MLR: 1.19 (0.41–3.43) M: NLR, PLR and MLR: NR | Low quality | |
Sedef 2018 [35] Turkey | September 2011–December 2017 | Retrospective. N = 117 Median: 61 years (39–83) | ED: 117 (100) | Platinum/etoposide: 117 (100) | 12 (10) | NR | NR | NLR: 3.28a PLR: 139.8a | 12 (range NR) 95 (81%) events during follow up | U: High NLR: 12 months vs low NLR 14 months p = 0.013 High PLR 13 months vs low PLR 13 months p = 0.66 | Low quality | |
Shao 2015 China [36] | January 2000–March 2009 | Retrospective. N = 112 Median: 62 years (45–82) | LD: 39 (35) ED: 73 (65) | Platinum/etoposide: 84 (75%) Platinum/irinotecan: 28 (25%) | 14 (13) | 105 (94) | 103 (92) | NLR: 4.15a PLR:150a | 68.5 (range NR) | U: NLR: p = 0.001 PLR: p = 0.101 M: NLR: 1.56 (1.16–1.96) PLR: NR | Stage, PS | Moderate quality |
Shen 2019 China [37] | September 2015–May 2019 | Retrospective. N = 178 Mean: 61 ± 9.27 | LD: 50 (28) ED: 128 (72) | Platinum/etoposide: 178 (100%) | 36 (20) | NR | NR | HALP: 25.8a | NR | NR | NR | Low quality |
Sonehara 2019 Japan [38] | January 2005–December 2018 | Retrospective. N = 83. Median: 72 years (43–86) | ED: 83 (100) | Platinum/irinotecan: 33 (40%) Platinum/etoposide: 46 (55%) Etoposide 1 (1%) Best supportive care: 3 (4%) | 13 (16) | 79 (95) | 60 (72) | mGPS: 0 / 1 / 2 PLR: 200 | NR | U: mGPS 0 vs 1: 1.83 (1.06–3.15) mGPS 0 vs 2: 2.28 (1.21–4.30) PLR: 1.52 (0.94–2.47) M: mGPS 0 vs. 1: 1.31 (0.72–2.34) mGPS 0 vs. 2: 2.34 (1.16–4.73) PLR: 0.91 (0.35–1.56) | Age, PS, LDH, bone metastasis, lever metastasis | Low quality |
Suzuki 2018 USA [39] | May 1998–September 2015 | Retrospective N = 252 Median: 63 years (IQR 56–69) | ED: 252 (100) | Platinum: 240 (95) TRT ≥ 45Gy: 113 (45) PCI: 49 (19) | 133 (53) | 247 (98) | 185 (73) | NLR: 4 PLR: 194.7 | NR | U: NLR: 1.64 (1.27–2.11) PLR: 1.20 (0.93–1.55) M: NLR: 1.52 (1.17–1.98) PLR: non-significant, data not reported | Age, sex, PS, number of chemo cycles, TRT ≥ 45 Gy, PCI | Moderate quality |
Suzuki 2019 Japan [40] | 2002–2015 | Retrospective. N = 122 Median: 65 years (Range NR) | LD: 122 (100) | Platinum/etoposide: 122 (100%) | 61 (50) | 111 (91) | 118 (97) | NLR: 2.9a PLR: 140.1a | NR | U: NLR: 1.68 (1.06–2.66) PLR: 1.85 (1.16–2.96) M: NLR: 1.86 (1.15–3.01) PLR: 1.72 (1.06–2.82) | Age, number of chemo cycles, stage | Moderate quality |
Wang 2020 China [41] | January 2008–December 2009 | Retrospective. N = 653 Median: 56 years (23–75) | LD: 384 (59) ED: 269 (41) | Platinum/etoposide: 653 (100%) RT: 267 (41%) Surgery: 22 (3%) | 231 (35) | 408 (63) | NR | SII:748.51a | NR | U: Low SII were associated with a prolonged OS 17 vs 12 months p < 0.001 M: 1.55 (1.30–1.86) | Age, sex, smoking, stage, LDH, distant metastasis, CRT, surgery + adjuvant CT | Low quality |
Wang 2019 China [42] | March 2009–August 2015 | Retrospective. N = 228 Median: 58 (39–71) | LD: 114(50) ED: 114 (50) | TRC platinum/etoposide 228 (100%) | 69 (30) | 181 (79) | KPS ≥ 80 186 (82) | SII: 479a NLR: 2.3a PLR: 125a LMR: 6.08a | 46 (range NR) | U: SII: 4.80 (3.42–6.74) PLR: 3.17 (2.15–4.66) NLR: 2.53 (1.84–3.48) LMR: 1.96 (1.40–2.75) M: SII: 2.67 (1.67–4.28) PLR: 1.95 (1.26–3.00) NLR: 1.38 (0.93–2.05) LMR: 1.32 (0.92–1.89) | Initial therapeutic response, extrapulmonary lesion, stage | Low quality |
Wang 2014 China [17] | January 2005–December 2010 | Retrospective. N = 114 Mean: 59 years | LD: 68 (60) ED: 46 (40) | Platinum/etoposide: 92 (80%) | 25 (22) | NR | 45 (39) | NLR: 3.0 PLR: 150 | NR | U: NLR: chi2 = 5.641, P = 0.018 PLR: NR M: NLR: 1.70 (1.05–2.75) PLR: NR | PS, stage | Moderate quality |
Wen 2017 China [43] | January 2005–December 2010 | Retrospective. N = 452 Median: 56 years (27–82) | LD: 452 (100) | Platinum/etoposide: 376 (83%) Platinum/irinotecan: 76 (17%) | 112 (25) | 322 (71) | 357 (79) | NLR: 4.0 PLR: NR | 35 (range NR) NR | U: NLR: p = 0.004 PLR: p = 0.016 M: NLR: 2.04 (1.02–4.10) PLR: NR | Number of cycles, treatment modality, LDH, NSE, platinum status, response to treatment | Moderate quality |
Wu 2020 [44] China | January 2008–October 2018 | Retrospective. N = 146 Mean: 57 years (19–74) | LD: 59 (40) ED: 87 (60) | Platinum/etoposide: 146 (100%) | 32 (22) | 108 (74) | 146 (100) | NLR: 3.0 PLR: 165 | 14 (5–138) 140 events during follow-up | U: NLR: 1.57 (1.08–2.29) PLR: 1.46 (1.02–2.11) | Moderate quality | |
Xie 2015 USA [45] | January 1997–December 2012 | Retrospective. N = 938 Median: 68 years (27–91) | LD: 383 (41) ED: 555 (59) | CT: 777 (83%) | 438 (47) | 921 (99) | 730 (78) | NLR: 5.0 PLR: 210a | 10.8 (range NR) 856 (91%)events during follow-up | U: PLR p < 0.0001 NLR p < 0.0001 RDW p < 0.0001 M: LD PLR: 1.60 (1.18–2.18) Loge (NLR): 1.16 (0.96–1.42) Loge (RDW): 0.84 (0.24–2.94) M: ED Loge (RDW): 2.81 (1.32–6.01) Loge (NLR): 1.41 (1.24–1.59) PLR: 0.83 (0.67–1.02) | Age, sex, PS, chest irradiation, CT, liver metastasis, number of metastatic sites | Low quality |
Zhang 2019 China [46] | January 2012–September 2015 | Retrospective. N = 286 < 65 years: 220 (77%) | LD: I: 20 (7) II: 48 (17) III: 218 (76) | Platinum/etoposide: 236 (83%) Other not specified: 50 (17%) | 84 (29) | 161 (56) | NR | PLR: 152.1a | 40 (4–74) 221 (77%) events during follow-up | U: p = 0.002 M: 1.33 (1.01–1.74) | Age, stage, treatment, initial treatment regimen, PCI | Low quality |
Zheng 2018 China [47] | January 2010–December 2016 | Retrospective. N = 153 Median: 59 years (23–80) | LD: I: 4 (3) II: 13 (8) III: 136 (89) | Platinum/etoposide: 153 (100%) | 49 (32) | 84 (55) | 139 (90) | NLR: 2.55a PLR: 125.7a | 42.5 (5.8–93.2) 88 (52%) events during follow-up | U: NR M: NLR: 2.14 (95%CI NR) PLR: NR | NR | Low quality |
Zhou 2014 China | January 2009–December 2011 | Retrospective. N = 359 Median: 60 years (22–82) | LD: 163 (45) ED: 196 (55) | Platinum / irinotecan: 174 (47%) Platinum / etoposide: 185 (53%) | 55 (15) | NR | 341 (95) | mGPS: 0 / 1 / 2 | NR 180 (50.1%) events during follow-up | U: 0 v 1 v 2: p < 0.001 M: 0 v 1 (n = 238v 110): 1.52 (1.08–2.13) 0 v 2 (N = 238 v 11): 5.23 (2.63–11.58) | PS, sex, stage | High quality |