Abstract
The role of platelet-to-lymphocyte ratio (PLR) in the prognosis of hepatocellular carcinoma (HCC) patients with different Barcelona Clinic Liver Cancer (BCLC) stages remains controversial. This systematic review and meta-analysis aimed to determine the efficacy of PLR on HCC prognosis. Five electronic databases were searched for clinical trials focusing on the role of PLR in the prognosis of HCC. A total of 297 potential studies were initially identified, and 9 studies comprising 2449 patients were finally enrolled to evaluate the association between the pretreatment PLR and clinical outcomes of overall survival (OS), disease-free survival (DFS), and event occurrence in patients with HCC in different BCLC stages. An elevated pretreatment PLR indicated unfavorable worse OS (HR = 1.73; 95% CI: (1.46, 2.04); P < 0.00001) and DFS (HR = 1.30; 95% CI: (1.06, 1.60); P = 0.01). Subgroup analysis indicated that high PLR indicated poor OS among BCLC-B/C patients without heterogeneity, while PLR in BCLC-A patients indicated high statistical heterogeneity with I2 value of 78%. As for the correlation between PLR and event occurrence, high PLR was related to poor clinical event occurrence only among BCLC-C patients, though obvious heterogeneity was observed in all different BCLC stages. In conclusion, PLR may be a significant biomarker in the prognosis of HCC in different BCLC stages.
Highlights
Inflammation, a protective immune response to harmful stimuli such as pathogens and dead cells, is mounted by the evolutionarily conserved innate immune system with tight regulation of host [1]
Two hundred and ninety-seven studies potentially relevant to this research project were initially identified after searching PubMed, Web of Science, EMBASE, Elsevier, and Cochrane Library
The results indicated that in total Barcelona Clinic Liver Cancer (BCLC) stages, the heterogeneity of the high-platelet-to-lymphocyte ratio (PLR) studies was 10%
Summary
Inflammation, a protective immune response to harmful stimuli such as pathogens and dead cells, is mounted by the evolutionarily conserved innate immune system with tight regulation of host [1]. More and more evidences have revealed that inflammatory response correlates closely with tumor progression such as angiogenesis and tumor invasion. It is verified that the invasion and migration of tumor cells correlate closely with inflammation-related cells, including lymphocytes [6], neutrophils [7, 8], and platelets [9]. Platelets are considered as crucial effector cells in hemostasis; extensive experiments have illuminated their potential role in inflammatory responses—they may recognize and kill invading pathogens and release various mediators modifying immune and endothelial cell responses [10]. As a crucial component of host immune surveillance system, lymphocyte plays an important role in patients with various types of Gastroenterology Research and Practice
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