Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in HCC patients has been extensively studied; however, the prognostic value of NLR in HCC patients undergoing curative treatment remains unclear. OBJECTIVE: This systematic review and meta-analysis aimed to comprehensively evaluate the precise significance of preoperative and postoperative NLR in predicting the prognosis of HCC patients receiving curative treatment. METHODS: We conducted a comprehensive search of the PubMed, Cochrane Library, Embase, and Web of Science databases from inception to August 2024. Studies that included univariate and multivariate analyses evaluating the association between NLR and survival outcomes in HCC patients undergoing resection, transplantation, or ablation were included. The prognostic value of NLR in HCC patients receiving curative treatment was analyzed by calculating pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). RESULTS: A total of 43 studies involving 9,952 patients were included. Meta-analysis revealed that higher NLR was significantly associated with worse overall survival (OS) (HR = 1.55, 95% CI = 1.39-1.75, P < 0.001), recurrence-free survival (RFS) (HR = 1.77, 95% CI = 1.49-2.10, P < 0.001), and disease-free survival (DFS) (HR = 1.42, 95% CI = 1.25-1.63, P < 0.001) in HCC patients undergoing curative treatment. Subgroup analysis demonstrated a significant association between NLR and poor OS, independent of geographic region, type of survival analysis, preoperative or postoperative measurement, treatment modality, or NLR cutoff value. Publication bias and sensitivity analyses confirmed the robustness of these findings. CONCLUSION: Elevated NLR is significantly associated with poorer OS, RFS, and DFS in HCC patients receiving curative treatment. Future research should focus on validating the optimal NLR threshold and exploring its predictive ability in different clinical settings.