Prognostic value of combined pretreatment fibrinogen and neutrophil-lymphocyte ratio in digestive system cancers: a meta-analysis of 17 retrospective studies

BACKGROUND: Several epidemiological studies have reported the relationship between the combined pretreatment fibrinogen and neutrophil-lymphocyte ratio (F-NLR) and prognosis of digestive system cancers (DSCs). However, the results are controversial. We aimed to assess the prognostic value of F-NLR in patients with DSCs. METHODS: A comprehensive search for relevant studies was conducted until June, 2020. Studies that evaluated the association of the F-NLR score with survival outcome in patients with any DSCs were included. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using a fixed-effects model. All data analyses were performed using the STATA 12.0 software. RESULTS: A total of 17 studies involving 5,767 participants were included in the meta-analysis. We found that high F-NLR score was significantly associated with poor overall survival (OS) in patients with DSCs (HR =2.0; 95% CI, 1.78–2.24). In addition, patients with high F-NLR score had poor disease-free survival/progression-free survival/recurrence-free survival (DFS/PFS/RFS) (HR =2.01; 95% CI, 1.47–2.74) and DFS (HR =1.97; 95% CI, 1.35–2.87). Sensitivity analyses for OS confirmed that the results were stable. CONCLUSIONS: High F-NLR score is significantly associated with poor prognostic outcomes in patients with DSCs and can serve as an effective prognostic indicator for the Asian population.