Prognostic value of platelet-to-lymphocyte ratio in bladder cancer: a systematic review and meta-analysis
Mengyuan Pan1,2, Tianyi Tao3, Jialing Peng4
1Graduate School, Henan Medical University, Xinxiang, 453003, China.
Background:
The prognosis of bladder cancer (BC) necessitates reliable biomarkers. The platelet-to-lymphocyte ratio (PLR), a composite indicator of systemic inflammation and immune status, has shown prognostic potential in multiple studies, but evidence remains inconsistent and incomplete regarding key survival outcomes.
Methods:
In accordance with the PRISMA guidelines, a systematic literature search was conducted through June 2026 across PubMed, Embase, Web of Science, and the Cochrane Library. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using a random-effects model to evaluate the association between elevated pretreatment PLR and overall survival (OS), recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS). Subgroup and sensitivity analyses were conducted, along with an evaluation of potential publication bias. All statistical procedures were executed using STATA version 15.0 and Review Manager version 5.4.
Results:
This meta-analysis included 26 studies involving a total of 5,807 patients. Elevated pretreatment PLR was significantly associated with shorter OS (HR = 1.56, 95% CI: 1.27-1.93), RFS (HR = 1.95, 95% CI: 1.47-2.59), PFS (HR = 1.85, 95% CI: 1.36-2.53), and CSS (HR = 1.56, 95% CI: 1.27-1.92). Sensitivity analysis confirmed the robustness of the results for OS, RFS, and PFS, while CSS results showed lower stability. Subgroup analysis revealed heterogeneity in the prognostic value of PLR, primarily driven by variations in PLR cut-off values, tumor type, patient age, geographic region, and treatment regimen. OS results showed signs of publication bias (Egger's test, P = 0.000), in contrast to RFS, PFS, and CSS.
Conclusion:
Elevated pretreatment PLR was significantly associated with adverse survival outcomes in patients with BC. As an accessible and cost-effective inflammatory-immune biomarker, PLR may serve as a useful adjunctive tool for risk stratification, although its independent clinical utility requires validation in prospective settings. Future prospective studies are warranted to establish standardized cut-off values and further clarify its role in prognostic assessment and personalized treatment decision-making.