Platelet to lymphocyte ratio as a prognostic marker for hepatocellular carcinoma

The prognostic value of platelet to lymphocyte ratio (PLR) in hepatocellular carcinoma (HCC) is controversial. Thus, a meta-analysis was carried out to evaluate the correlation between PLR and outcomes as well as clinical characteristics in HCC. Studies were identified through searching PubMed, Embase, and Web of Science. The combined hazard ratio (HR) with 95% confidence interval (CI) was computed to estimate the impact of PLR on survival. Odd ratio (OR) and 95% CI were calculated to investigate the relationship between PLR and clinical factors. Pooled results from 16 studies involving 3,812 patients indicated that an elevated PLR was significant with poor overall survival (OS) (HR=1.32, 95% CI: 1.15-1.52, P<0.001), disease-free survival (DFS) (HR=1.6, 95% CI: 1.31-1.95, P<0.0010, and recurrence-free survival (RFS) (HR=1.63, 95% CI: 1.37-1.93, P<0.001). Moreover, a high PLR was correlated to the presence of HBV infection, larger tumor size, age ≥60 years, higher Barcelona Clinic Liver Cancer (BCLC) stage, and high Cancer of the Liver Italian Program (CLIP) score. This meta-analysis showed that an elevated PLR was an indicator of poor OS, DFS, and RFS in HCC. In addition, a high PLR was also correlated with poor clinical conditions of HCC patients.