Prognostic value of NLR versus PLR and LMR in patients with oral squamous cell carcinoma: a meta-analysis

The prognostic value of inflammatory biomarkers like neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in oral squamous cell carcinoma (OSCC) requires further validation. This updated meta-analysis evaluates the impact of these biomarkers on OSCC survival and aims to identify the most effective indicator. We searched PubMed, MEDLINE, Embase, and Web of Science until February 1, 2026. Hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were analyzed using random- or fixed-effects models. Evidence stability was assessed through cumulative meta-analysis and trial sequential analysis (TSA), while restricted mean survival time (RMST) analysis measured survival differences between NLR subgroups. Subgroup and sensitivity analyses were conducted to examine heterogeneity and robustness. Out of 1,193 articles, 35 retrospective studies involving 12,225 OSCC patients were included. High pretreatment NLR was significantly associated to poorer OS (HR = 1.61) and DFS (HR = 1.64), confirmed by sufficient cumulative information size in TSA. While high PLR was associated with poor OS, the results showed marked heterogeneity and instability. LMR did not reach statistical significance for OS, confirmed by sufficient evidence in TSA. Current evidence suggests that NLR is a robust prognostic biomarker for OSCC. Given the observational nature of the included studies, future prospective studies are necessary to validate these findings and establish standardized NLR thresholds to guide risk stratification and personalized management.