The predictive value of NLR and PLR for TACE prognosis in hepatocellular carcinoma: a systematic review and meta-analysis

Introduction: The purpose of this study was to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for outcomes in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Content: We conducted a systematic search on PubMed, Embase, the Cochrane Library, and Web of Science, with a deadline of June 15, 2025. The statistical analysis of this study was conducted using R software (version 4.3.1). This meta-analysis was reported in accordance with the PRISMA guidelines. The research has been registered in PROSPERO (CRD42022361556). Summary: A total of 24 studies, involving 9,257 patients, were included. Our study suggested that elevated NLR values were associated with poorer overall survival (OS) (hazard ratio [HR]=1.73; 95 % confidence interval [CI]: 1.42-2.10) and progression-free survival (PFS) (HR=1.44, 95 % CI: 1.28-1.63) in patients. However, there was no statistically significant difference between the elevated PLR values and patient's OS (HR=1.26, 95 % CI: 0.92-1.73) and PFS (HR=1.86, 95 % CI: 0.45-7.78). Outlook: Our meta-analysis suggested that high NLR before TACE was a predictor of poor OS and PFS prognosis in HCC patients after TACE. However, the prognostic value of PLR was not statistically significant and further prospective studies were needed to validate them.