Neutrophil to Lymphocyte Ratio in Meningioma: A Systematic Review and Meta-Analysis

There is emerging data on potential novel inflammatory biomarkers associating brain tumors, including the neutrophil-to-lymphocyte ratio (NLR). However, there has not been a comprehensive study of the potential role of NLR in meningioma. The objective of this paper is to assess whether NLR can be a useful indicator of prognosis and diagnosis for individuals with meningioma. Methods: We conducted a thorough systematic review and meta-analysis following the PRISMA guidelines to collect all relevant published materials, including preprints and grey literature. Two unbiased reviewers conducted a systematic literature search in PubMed, Web of Science, and Scopus using (meningioma) AND ((neutrophil-lymphocyte ratio) OR NLR OR (neutrophil-lymphocyte ratio). Our final search was updated on ۳ August ۲۰۲۳, with no language or publication year limitations. We also searched reference lists of relevant articles and checked the Prospero Register for unpublished studies. To find additional studies, we conducted a supplementary search on Google Scholar as a secondary database. Results: Initially, ۳۴۳ records were found through database and other searches. After removing duplicates and irrelevant records, ۲۳ studies included in qualitative synthesis and ۱۳ studies included in meta-analysis. It was discovered that patients with high-grade meningioma had higher NLR levels compared to those with low-grade meningioma (SMD=۰.۷۲, ۹۵% CI: ۰.۲۱-۱.۲۳, p=۰.۰۰۶). It was also observed that there was no significant difference in NLR levels between patients with meningioma and those with gliomas (SMD, -۰.۱۹, ۹۵% CI: -۰.۴۷-۰.۱۰, p=۰.۲۰). Furthermore, patients with meningioma had higher NLR levels than healthy controls (SMD=۰.۵۶, ۹۵% CI: ۰.۲۴-۰.۸۸, p=۰.۰۱). Studies indicated that an NLR > ۲.۴ distinguished between high-grade and low-grade meningioma, an NLR > ۲.۷۴ differentiated between high and low progression-free survival groups, and an NLR > ۲.۵۹ was linked to recurrence with high sensitivity and specificity. However, NLR was not a predictor of postoperative pneumonia following meningioma resection. Due to conflicting results, further research is needed to clarify the differences in NLR levels in meningioma and other pathologies. Conclusion: The NLR demonstrates a meaningful diagnostic and prognostic utility in the context of meningioma. Our analysis suggests a robust association between systemic inflammation, as indicated by elevated NLR levels, and the presence of meningioma, as demonstrated by higher NLR levels in patients with meningioma compared to healthy individuals. Furthermore, NLR proves to be a valuable predictor of the progression and recurrence of meningioma. NLR has the potential to inform clinical decision-making as an inflammatory marker, offering insights into therapeutic outcomes in patients with meningioma.

کلیدواژه ها:

Inflammation ، Lymphocyte ، Meningioma ، Neutrophil ، Review