Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in hepatocellular carcinoma: From inflammation to clinical applications

Hepatocellular carcinoma (HCC) is the predominant type of primary liver cancer, with a rising global incidence and a high mortality rate. Chronic infections with hepatitis viruses, along with risk factors such as cirrhosis, metabolic dysfunction-associated steatohepatitis, and metabolic disorders, significantly contribute to HCC development. Systemic inflammation plays a key role in HCC pathogenesis, with inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) emerging as significant prognostic indicators. Elevated NLR and PLR are associated with poor overall survival and progression-free survival in HCC patients, reflecting an imbalance in the immune response and tumor microenvironment (TME). Neutrophils and platelets contribute to tumor progression by promoting inflammation, angiogenesis, and immune evasion, while lymphocytes, particularly CD8+ T-cells, play essential roles in antitumor immunity. High levels of NLR and PLR are linked to adverse clinical outcomes, including shorter survival times and higher recurrence rates. These ratios provide valuable prognostic information and are increasingly utilized in clinical settings to guide treatment decisions. This review focuses on the roles of inflammatory markers, particularly NLR and PLR, in HCC progression and prognosis, examining their effects on the TME and their potential for improving diagnostic and prognostic strategies. The use of these inflammatory markers and emerging technologies holds promise for enhancing early detection and personalized treatment strategies, ultimately improving patient outcomes in HCC.