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Higher preoperative neutrophil-to-lymphocyte ratio predicts poorer survival in oral squamous cell carcinoma patientsHigh white blood cell ratios predict survival in oral cancer

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Key Takeaway
Note that higher preoperative NLR is associated with significantly poorer survival outcomes in oral squamous cell carcinoma.

This meta-analysis synthesized 30 studies to evaluate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with oral squamous cell carcinoma (OSCC). The analysis focused on survival outcomes to determine if NLR could serve as a viable clinical biomarker.

The meta-analysis found that a higher preoperative NLR was significantly associated with poorer outcomes in three key areas: overall survival (HR 1.79, 95% CI: 1.48-2.16, P <.001), disease-free survival (HR 1.70, 95% CI: 1.48-1.94, P <.001), and disease-specific survival (HR 2.10, 95% CI: 1.72-2.57, P <.001). However, no significant association was found between NLR and progression-free survival (HR 1.24, 95% CI: 0.78-1.99, P =.367).

While the results remained robust after trim and fill methods, the authors noted the limitation of a limited number of included studies. Clinically, the findings suggest that elevated preoperative NLR may serve as a low-cost prognostic biomarker for identifying patients with a poorer survival prognosis in the management of OSCC.

How this fits prior evidence

This meta-analysis addresses a gap in identifying low-cost prognostic biomarkers for oral squamous cell carcinoma. While previous evidence has explored diagnostic tools like deep learning, hyperspectral imaging, and circulating miRNAs, this finding specifically addresses survival prognosis using the neutrophil-to-lymphocyte ratio. It complements other findings regarding the management of oral squamous cell carcinoma, such as the use of Ninjin’yoeito to address nutritional decline post-surgery.

When a patient faces a diagnosis of oral squamous cell carcinoma, doctors look for every possible tool to predict how the disease will progress. A new look at 30 different studies shows that a specific blood cell ratio can provide important clues. This ratio compares neutrophils, which are a type of white blood cell, to lymphocytes, which are another type of white blood cell.

Researchers found that a higher ratio of these cells before surgery is linked to a higher risk of poorer survival. Specifically, patients with a higher ratio showed lower rates of overall survival, disease-free survival, and disease-specific survival. While the data did not show a clear link to how long a patient lived without the cancer progressing, the connection to overall survival remains a strong signal.

Because this test uses common blood counts, it could serve as a low-cost way to help doctors predict a patient's outlook. However, it is important to note that the findings come from a limited number of studies. While the results are consistent, the small number of studies means the evidence is still developing.

What this means for you:
A high neutrophil-to-lymphocyte ratio before surgery can help predict survival outcomes in oral cancer patients.

Common questions

What is the neutrophil-to-lymphocyte ratio?

This is a ratio that compares two types of white blood cells: neutrophils and lymphocytes. Doctors can measure these cells in a standard blood test before a patient undergoes surgery for oral squamous cell carcinoma.

How does this test help patients with oral cancer?

A higher ratio of these cells before surgery is linked to a higher risk of poorer survival outcomes. It may serve as a low-cost way for doctors to predict a patient's prognosis after they have been diagnosed.

Is this test a guaranteed way to predict cancer progression?

The study did not find a significant link between the blood cell ratio and progression-free survival. While it helps predict overall survival, it does not currently show a clear link to how long a patient lives without the cancer progressing.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: The incidence of oral squamous cell carcinoma (OSCC) has been rising in recent years, substantially affecting patients' quality of life and psychological well-being. Identifying effective prognostic indicators is critical for guiding clinical decision-making. Currently, the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in OSCC remains controversial. This meta-analysis aimed to systematically examine the relationship between preoperative NLR and postoperative survival outcomes among individuals with OSCC. METHODS: Studies on the association between preoperative NLR and postoperative overall survival (OS), disease-free survival (DFS), and other survival outcomes in OSCC patients were systematically searched from the Cochrane Library, Web of Science, Embase, and PubMed from inception to March 1, 2025. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias. Stata 15 was utilized to perform statistical analyses. RESULTS: In total, 30 studies were included, all of which had a Newcastle-Ottawa Scale score of 7 or higher. Among them, 21 studies reported OS, 10 reported disease-specific survival (DSS), 3 reported progression-free survival, and 11 reported DFS. The meta-analysis results suggested that a higher preoperative NLR was significantly associated with poorer postoperative OS (hazard ratio [HR] = 1.79, 95% confidence interval [CI]: 1.48-2.16; P < .001), DFS (HR = 1.70, 95% CI: 1.48-1.94; P < .001), and DSS (HR = 2.10, 95% CI: 1.72-2.57; P < .001) in individuals with OSCC. No significant association was found between NLR and progression-free survival (HR = 1.24; 95% CI: 0.78-1.99; P = .367). Sensitivity analyses revealed that the pooled effect sizes for OS, DSS, and DFS did not significantly change. The publication bias assessment results showed that significant publication bias was found for OS, DFS, and DSS (P < .05). After the trim and filling method, the direction of the pooled effect size did not reverse, and the 95% CI of the effect estimates remained statistically stable, indicating that the study results were relatively robust. CONCLUSION: Elevated preoperative NLR may be an effective predictor of poor survival prognosis among individuals with OSCC and may be applied as a low-cost prognostic biomarker to assist in prognostic prediction. However, due to the limited number of included studies, high-quality research is warranted in the future to validate these findings.
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