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Prognostic significance of pre‐operative inflammatory markers in resected gallbladder cancer: a systematic review
Author(s) -
Saqib Rukhtam,
Pathak Samir,
Smart Neil,
Nunes Quentin,
Rees Jonathan,
Finch Jones Margaret,
Poston Graeme
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14300
Subject(s) - medicine , gallbladder cancer , cinahl , oncology , c reactive protein , adjuvant therapy , medline , prospective cohort study , cancer , psychological intervention , inflammation , psychiatry , political science , law
Background Neutrophil to lymphocyte ratio (NLR), C‐reactive protein (CRP) and Glasgow Prognostic Score (GPS) have demonstrated good prognostic value in several cancers but their role in gallbladder cancer (GBC) remains unclear. The aim of this study is to systematically review the current literature to determine their role in predicting survival outcomes in GBC. Methods Using a pre‐specified inclusive search strategy MEDLINE, EMBASE and CINAHL databases were used to identify studies describing survival in patients after GBC resection with high or low pre‐operative CRP, GPS or NLR. A proforma was used to extract study author and date, number of patients, age, gender, tumour stage, use of adjuvant therapy and primary outcome data. Results In all, 46 studies were identified after initial screening with four studies reporting survival outcomes. All studies described a reduction in survival in patients with an elevated NLR, GPS or CRP. Three studies showed NLR to be an independent prognostic marker and one study additionally demonstrated that elevated CRP and GPS were associated with poorer survival. Conclusions Elevated pre‐operative inflammatory markers are inversely related to survival outcomes. They are relatively inexpensive, easy measurable parameters that could aid in the decision making process involved in the management of GBC. Sub‐stratification of groups utilizing inflammatory markers may help guide surgical strategy. However, these studies are retrospective and of low to moderate quality. High quality, prospective studies with well‐defined inclusion criteria and outcomes are needed to guide the role of inflammatory markers in the management of GBC.