Prognostic Value of the Neutrophil-To-Lymphocyte Ratio in Patients with Oral Squamous Cell Carcinoma: A Systematic
Yan Wang1, Chen Peng2, Wei Ding2
1Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Third Hospital of Shanxi Medical University, The Third Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China.
Background:
The incidence of oral squamous cell carcinoma (OSCC) has been rising in recent years, substantially affecting patients' quality of life and psychological well-being. Identifying effective prognostic indicators is critical for guiding clinical decision-making. Currently, the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in OSCC remains controversial. This meta-analysis aimed to systematically examine the relationship between preoperative NLR and postoperative survival outcomes among individuals with OSCC.
Methods:
Studies on the association between preoperative NLR and postoperative overall survival (OS), disease-free survival (DFS), and other survival outcomes in OSCC patients were systematically searched from the Cochrane Library, Web of Science, Embase, and PubMed from inception to March 1, 2025. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias. Stata 15 was utilized to perform statistical analyses.
Results:
In total, 30 studies were included, all of which had a Newcastle-Ottawa Scale score of 7 or higher. Among them, 21 studies reported OS, 10 reported disease-specific survival (DSS), 3 reported progression-free survival, and 11 reported DFS. The meta-analysis results suggested that a higher preoperative NLR was significantly associated with poorer postoperative OS (hazard ratio [HR] = 1.79, 95% confidence interval [CI]: 1.48-2.16; P < .001), DFS (HR = 1.70, 95% CI: 1.48-1.94; P < .001), and DSS (HR = 2.10, 95% CI: 1.72-2.57; P < .001) in individuals with OSCC. No significant association was found between NLR and progression-free survival (HR = 1.24; 95% CI: 0.78-1.99; P = .367). Sensitivity analyses revealed that the pooled effect sizes for OS, DSS, and DFS did not significantly change. The publication bias assessment results showed that significant publication bias was found for OS, DFS, and DSS (P < .05). After the trim and filling method, the direction of the pooled effect size did not reverse, and the 95% CI of the effect estimates remained statistically stable, indicating that the study results were relatively robust.
Conclusion:
Elevated preoperative NLR may be an effective predictor of poor survival prognosis among individuals with OSCC and may be applied as a low-cost prognostic biomarker to assist in prognostic prediction. However, due to the limited number of included studies, high-quality research is warranted in the future to validate these findings.