Meta-analysis links high monocyte-to-lymphocyte ratio to poor survival in hepatocellular carcinoma

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Frontiers in Medicine Published May 8, 2026 Medically reviewed May 8, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider MLR as a potential prognostic marker in HCC, but recognize the need for further validation.

This meta-analysis evaluated the prognostic value of the monocyte-to-lymphocyte ratio (MLR) in patients with hepatocellular carcinoma (HCC). The analysis included 7113 patients and assessed outcomes including overall survival (OS), recurrence-free survival (RFS), progression-free survival (PFS), and disease-free survival (DFS).

High MLR was significantly associated with poor OS (HR 1.57, 95% CI 1.22-2.02), poor RFS (HR 2.40, 95% CI 1.73-3.33), and poor PFS (HR 2.04, 95% CI 1.57-2.65). However, high MLR was not associated with DFS (HR 1.01, 95% CI 0.86-1.18).

The authors note that MLR may be a valuable and non-invasive prognostic indicator for HCC patients in clinical practice. Limitations of the meta-analysis were not explicitly reported, but as with any meta-analysis of observational studies, residual confounding and heterogeneity across studies should be considered.

Clinicians should interpret these findings cautiously. While MLR shows promise as a simple, inexpensive prognostic marker, further prospective studies are needed to establish its clinical utility and optimal cutoff values.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundThe monocyte-to-lymphocyte ratio(MLR) as an immune indicator has been found to be associated with the prognosis of various tumors. This study aimed to determine prognostic value of MLR in patients with hepatocellular carcinoma (HCC) by the meta-analysis.MethodsA comprehensive literature search was conducted in PubMed, Web of Science, and Embase up to July 25, 2025. Survival outcome included overall survival (OS), recurrence free survival (RFS), progression-free survival (PFS), and disease-free survival (DFS) were analyzed.ResultsA total of 17 studies comprising 7113 patients were included in the meta-analysis. The pooled results displayed that high MLR was significantly associated with poor OS (HR:1.57,95% CI:1.22-2.02), RFS(HR:2.40,95%CI:1.73-3.33) and PFS(HR:2.04,95%CI:1.57-2.65).However, high MLR was not associated with DFS(HR:1.01,95%CI:0.86-1.18). The prognostic relevance of MLR in HCC was consistently demonstrated across subgroup analyses.ConclusionHigh MLR was associated with poor prognosis in patients with HCC. MLR may be a valuable and non-invasive prognostic indicator for HCC patients in clinical practice.