Evidence map›Paper›PMID 40689991›Full record

ArticleEuropean journal of pediatrics2025

C-reactive protein-to-lymphocyte ratio and hemoglobin-to-red cell distribution width ratio as effective prognostic predictors in pediatric patients with neuroblastoma.

Qi Wu, Chencheng Xu, Zhiyao Cao, Jingchun Lv, Yali Han, Gebu Teng, Zhou Wu, Feng Tian, Dapeng Jiang

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Article in European journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Qi WuDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.ORCID http://orcid.org/0009-0006-7627-7331
Chencheng XuDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Zhiyao CaoDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Jingchun LvDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Yali HanDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Gebu TengDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Zhou WuDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China.
Feng TianDepartment of Pediatric Surgery, Suzhou Wujiang District Children's Hospital, Suzhou, Jiangsu Province, 215000, People's Republic of China.
Dapeng JiangDepartment of Oncology (Ward2), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200100, People's Republic of China. jdp509@163.com.

Funding

Health Research Project of Shanghai Pudong New Area Health Commission PW2023D-04Shanghai Hospital Development Center Foundation SHDC22022306Suzhou Young Health Talents "National Mentorship" Training project Qngg2024059
6 · The paper itself

Abstract

Inflammatory responses critically influence tumor progression, yet traditional inflammatory biomarkers in neuroblastoma (NB) research lack optimal sensitivity and specificity. This study aimed to evaluate the prognostic value of two pretreatment inflammatory biomarkers: the C-reactive protein-to-lymphocyte ratio (CLR) and hemoglobin-to-red cell distribution width ratio (HRR) in NB patients. A retrospective analysis was conducted on NB patients diagnosed and treated at Shanghai Children's Medical Center (2016-2022). Pretreatment blood parameters (within 1 week before therapy) were utilized to calculate CLR, HRR, and conventional biomarkers. Optimal cutoff values for each inflammatory biomarker were defined separately. Multivariate Cox regression models identified independent prognostic factors, while Kaplan-Meier curves with log-rank tests assessed survival differences. The cohort included 201 NB children (95 males, 106 females; median age, 37 months). CLR and HRR demonstrated clinically significant predictive accuracy (AUC > 0.7) over traditional biomarkers for both progression-free and overall survival. Elevated ferritin (hazard ratio = 0.35; 95% confidence interval, 0.14-0.90; P = 0.030) independently predicted poor short-term outcomes. For long-term survival, high CLR (hazard ratio = 0.20; 95% confidence interval, 0.05-0.86; P = 0.031) and low HRR (hazard ratio = 2.91; 95% confidence interval, 1.19-7.13; P = 0.019) were significant independent predictors. Kaplan-Meier survival curves demonstrated that high CLR and low HRR were associated with poor long-term outcomes in NB patients (P < 0.05). Intergroup comparisons indicated that the high-CLR and low-HRR groups were predominantly composed of high-risk M-stage patients (P < 0.05).

conclusionCLR and HRR outperform conventional inflammatory biomarkers as pretreatment prognostic indicators in NB. Elevated CLR and reduced HRR were strongly linked with advanced-stage grouping and adverse long-term outcomes and may serve as effective practical tools for enhancing clinical risk stratification in pediatric NB. WHAT IS KNOWN: •Neuroblastoma is the most common extracranial solid malignancy in children, and inflammatory biomarkers can effectively predict its prognosis. WHAT IS NEW: •CLR and HRR are cost-effective biomarkers that enhance risk stratification and correlate strongly with adverse long-term prognosis in NB.

Indexed as

C-Reactive ProteinErythrocyte IndicesHemoglobinsLymphocytesNeuroblastomaBiomarkersBiomarkers, TumorChildChild, PreschoolFemaleHumansInfantKaplan-Meier EstimateLymphocyte CountMalePredictive Value of TestsBiomarkersBiomarkers, TumorC-Reactive ProteinHemoglobinsC-reactive protein-to-lymphocyte ratioHemoglobin-to-red cell distribution width ratioInflammatory biomarkersNeuroblastomaPrognosis

Identifiers

PMID40689991

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.