Prognostic value of preoperative platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma: a Meta-analysis

Objective To systematically investigate the prognostic value of preoperative platelet-to-lymphocyte ratio ( PLR) in patients with hepatocellular carcinoma ( HCC) . Methods Medline, EMBASE, Cochrane Library, CNKI, CBM, VIP, and Wanfang Data were searched for studies assessing the association between preoperative PLR and prognosis of HCC published up to January 2017. Two reviewers independently screened the articles according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality, and then a meta-analysis was performed using Rev Man 5. 3 software. The chi-square test was used for the analysis of heterogeneity between studies. Results A total of 18 articles with 4193 patients were included. The meta-analysis showed that compared with those with low PLR, patients with high PLR had significantly lower overall survival ( OS) rate ( hazard ratio [HR]= 1. 74, 95% confidence interval[CI]1. 42-2. 14, P < 0. 001) and disease-free survival rate or relapse-free survival rate ( HR = 1. 76, 95% CI: 1. 56-1. 98, P <0. 001) . The subgroup analysis revealed that patients with high PLR had significantly shorter OS than those with low PLR, regardless of race ( Asian or Caucasian) , treatment method ( surgery, chemotherapy, or multimodality therapy) , sample size ( ≥200 or < 200) , cut-off value of PLR ( ≥150 or < 150) , and NOS score ( ≥7 or < 7) ( all P < 0. 05) . Conclusion High preoperative PLR is closely associated with poor prognosis of HCC patients, suggesting that PLR might be a prognostic factor in HCC patients.