Prognostic significance of inflammation-based markers in nasopharyngeal carcinoma: a systematic review and meta-analysis

Background: Inflammation plays a pivotal role in tumor progression and prognosis. In nasopharyngeal carcinoma (NPC), several hematologic markers derived from systemic inflammation have emerged as potential prognostic indicators. This study aims to evaluate the prognostic value of inflammation-based indices in NPC systematically. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed, Embase, Scopus, and Web of Science was performed to identify eligible studies from January 2015 to December 2025. Nine studies involving 2, 986 NPC patients were included. Biomarkers assessed included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV). Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for overall survival (OS) and progression-free survival (PFS). Results: Elevated inflammation-based markers were significantly associated with poor prognosis in NPC. The pooled HR for OS was 1.86 (95% CI: 1.42-2.43), and for PFS was 1.74 (95% CI: 1.31-2.30). Among individual markers, SII and SIRI showed the strongest associations with poor outcomes (HR = 2.01 and 1.93, respectively). In contrast, a higher LMR was associated with better prognosis (HR = 0.72, 95% CI: 0.53-0.98). Sensitivity and subgroup analyses confirmed the robustness and consistency of findings. No significant publication bias was detected. Conclusion: Systemic inflammation-based biomarkers, particularly SII and SIRI, are strong, independent predictors of survival in NPC. Their integration into clinical practice may enhance prognostic stratification and inform treatment decisions. Future prospective studies are warranted to validate these findings and standardize biomarker thresholds.