The Prognostic Significance of Platelet-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte in Colorectal Cancer: a Meta-Analysis

Oct 6, 2025Journal of gastrointestinal cancer

Blood Cell Ratios Linked to Outcomes in Colorectal Cancer: A Review of Studies

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Abstract

High platelet-to-lymphocyte ratio (PLR) is associated with a 23% increased risk of mortality in colorectal cancer patients.

High PLR correlates with increased mortality risk (HR = 1.23, 95% CI = 1.04-1.44, p = 0.01).
Low lymphocyte-to-monocyte ratio (LMR) is linked to a 63% higher risk of mortality (HR = 1.63, 95% CI = 1.29-2.06, p < 0.0001).
No significant association was found between PLR and recurrence-free interval (DFS) (HR = 1.14, 95% CI = 0.93-1.40, p = 0.21).
Low LMR increases recurrence risk by 31% (HR = 1.31, 95% CI = 1.15-1.48, p < 0.0001).
High PLR and low LMR are associated with worse cancer-specific survival (CSS), with no significant heterogeneity observed.

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BACKGROUND: This comprehensive review sought to investigate the correlation between PLR and LMR with overall longevity (OS), recurrence-free interval (DFS), and malignancy-related survival (CSS) among individuals diagnosed with colorectal carcinoma.

METHODS: A comprehensive review of relevant studies was carried out using prominent digital repositories to locate research articles that provided hazard estimates (HRs) for PLR and LMR in individuals diagnosed with colorectal cancer. Potential publication bias was examined through graphical funnel plot assessments, while additional subgroup analyses were conducted based on patient demographics and consideration of C-index.

RESULTS: Nineteen studies were included for PLR and OS analysis, showing that high PLR was associated with increased mortality risk (HR = 1.23, 95%CI = 1.04-1.44, p = 0.01). For LMR and OS, 14 studies were analyzed, indicating that low LMR was linked to higher mortality risk (HR = 1.63, 95%CI = 1.29-2.06, p < 0.0001). Subgroup analyses showed stronger associations in the western population and studies with C-index adjustments. Regarding DFS, no significant association was found with PLR (HR = 1.14, 95%CI = 0.93-1.40, p = 0.21), while low LMR increased recurrence risk (HR = 1.31, 95%CI = 1.15-1.48, p < 0.0001). High PLR and low LMR were associated with worse CSS, with no significant heterogeneity observed.

CONCLUSION: Elevated PLR and reduced LMR are linked to unfavorable survival prospects in individuals with colon malignancy.

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The Prognostic Significance of Platelet-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte in Colorectal Cancer: a Meta-Analysis

Abstract

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