The serum platelet-to-lymphocyte ratio as a predictor of outcomes in bladder cancer patients: an updated meta-analysis

There is conflicting evidence regarding the association between platelet-lymphocyte ratio (PLR) and the prediction of outcomes in bladder cancer (BCa). Due to the rapidly increasing availability of data to explore this issue, this updated meta-analysis investigates how pretreatment PLR influences the outcomes of BCa. Literature was retrieved from Embase, Cochrane Library, Web of Science, and PubMed from 2015 to April 2025. The 95% confidence intervals (CIs) and pooled hazard ratio (HR) have been employed in the exploration of the link across BCa prediction and PLR. The 95% CIs and pooled odds ratios (ORs) examined the connection between PLR and clinicopathological features of BCa. Subgroup analysis and meta-regression were conducted to identify the main sources of heterogeneity. Sensitivity analysis was used to assess the robustness of the results. The Egger's test and "trim and fill" method have been used in evaluating publication bias. This study incorporated 20 studies comprising 5,594 participants. Elevated PLR was conspicuously linked to inferior overall survival (OS) (HR = 1.51, 95% CI 1.23-1.85, P < 0.001) and recurrence-free survival (RFS) (HR = 1.68, 95% CI 1.26-2.24, P < 0.001). A marginally significant association was observed between high PLR and progression-free survival (PFS) (HR = 1.61, 95% CI1.00-2.59, P = 0.052). No strong correlation between PLR and cancer-specific survival (CSS) (HR = 1.14, 95% CI 0.96-1.35, P = 0.138). Additionally, elevated PLR was significantly associated with tumor stage ≥ T2 (OR = 1.92, 95% CI 1.24-2.97, P = 0.003). The PLR can be regarded as an indicative predictor of the destitution of individuals suffering from BCa.