Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review

BACKGROUND The inflammatory response to tumor has been proven to be closely related to the prognosis of colorectal cancer.Neutrophil to lymphocyte ratio(NLR)is a widely available inflammatory biomarker that may have prognostic value for patients with colorectal liver metastasis(CRLM).AIM To assess the role of NLR as a prognostic factor of survival and tumor recurrence in patients with CRLM.METHODS A systematic literature search of PubMed,Cochrane Library and clinicaltrials.gov was conducted by two independent researchers in order to minimize potential errors and bias.Conflicts were discussed and settled between three researchers.Studies including patients undergoing different types of medical interventions for the treatment of CRLM and evaluating the correlation between pretreatment NLR and disease-free survival(DFS)and overall survival(OS)were included in the review.Nineteen studies,involving 3283 patients matched our inclusion criteria.RESULTS In the studies included,NLR was measured before the intervention and the NLR thresholds ranged between 1.9 and 7.26.Most studies used 5 as the cut-off value.Liver metastases were treated with hepatectomy with or without chemotherapy regimens in 13 studies and with radiofrequency ablation,radioembolization,chemoembolization or solely with chemotherapy in 6 studies.High NLR was associated with decreased OS and DFS after liver resection or other medical intervention.Moreover,high NLR was associated with poor chemosensitivity.On the contrary,CRLM patients with low pretreatment NLR demonstrated improved OS and DFS.NLR could potentially be used as a predictive factor of survival and tumor recurrence in patients with CRLM treated with interventions of any modality,including surgery,chemotherapy and ablative techniques.CONCLUSION NLR is an inflammatory biomarker that demonstrates considerable prognostic value.Elevated pretreatment NLR is associated with poor OS and DFS in patients with CRLM who are submitted to different treatments.

Laparoscopic surgery for colorectal liver metastases:moving forward while keeping feet on the ground

The laparoscopic approach to the surgical treatment of colorectal liver metastases(CRLMs)is supported nowadays by high evidence(1).In the hand of expert surgeons,patients undergoing laparoscopic liver surgery(LLS)for CLRMs benefit from a number of advantages,including a shorter postoperative in-hospital stay,less pain,fewer complications and a faster recovery(1).More importantly,all these profits are achieved while preserving the oncological outcomes,which are not-inferior to those achieved by open procedures(1).Recently published long-term results of randomized trials have shown similar patient survival after laparoscopic and open surgery for CRLM(2).

Big size is not all, even better!

We read with interest the article entitled"Comprehensive Complication Index validates improved outcomes over time despiteincreased complexity in 3707 consecutive hepatectomies"by Cloydet al.(1).This article focused on the correlation betweensurgical volume and the development of competency in openliver surgery.