Cai WM, Jiang W, He BF, Yu JJ, Zeng XH, Peng L, Liu S. Elevated pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in cholangiocarcinoma: A large-scale meta-analysis of 48 cohorts. World J Gastrointest Oncol 2026; 18(11): 124040 [DOI: 10.4251/wjgo.124040]
Corresponding Author of This Article
Lei Peng, PhD, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Avenue, Guangzhou 510000, Guangdong Province, China. 1015425249@qq.com
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Gastroenterology & Hepatology
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Cai WM, Jiang W, He BF, Yu JJ, Zeng XH, Peng L, Liu S. Elevated pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in cholangiocarcinoma: A large-scale meta-analysis of 48 cohorts. World J Gastrointest Oncol 2026; 18(11): 124040 [DOI: 10.4251/wjgo.124040]
World J Gastrointest Oncol. Nov 15, 2026; 18(11): 124040 Published online Nov 15, 2026. doi: 10.4251/wjgo.124040
Elevated pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in cholangiocarcinoma: A large-scale meta-analysis of 48 cohorts
Wen-Miao Cai, Wei Jiang, Bao-Feng He, Jun-Jie Yu, Xian-Hua Zeng, Lei Peng, Sun Liu
Wen-Miao Cai, Wei Jiang, Bao-Feng He, Jun-Jie Yu, Xian-Hua Zeng, Sun Liu, Department of Surgery, First People’s Hospital of Changde City, Changde 410000, Hunan Province, China
Lei Peng, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Wen-Miao Cai and Wei Jiang.
Co-corresponding authors: Lei Peng and Sun Liu.
Author contributions: Cai WM, He BF, Yu JJ, Zeng XH, Peng L, and Liu S contributed to manuscript review and editing; Cai WM, Jiang W, Yu JJ, and Zeng XH contributed to supervision; Cai WM, Jiang W, Yu JJ, Zeng XH, and Peng L contributed to methodology; Cai WM contributed to resources, project administration, and conceptualization; Cai WM and Jiang W contributed equally to this manuscript as co-first authors; Cai WM, Jiang W, He BF, and Zeng XH contributed to investigation; Jiang W and Yu JJ contributed to formal analysis; Jiang W contributed to writing of the original draft; Jiang W and Liu S contributed to data curation; Peng L and Liu S contributed equally to this manuscript as co-corresponding authors. All authors have read and approved the final manuscript.
AI contribution statement: The authors used Grammarly solely for English language editing and proofreading of the manuscript. The authors reviewed and edited the AI-generated text and take full responsibility for the content and accuracy of the final publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Lei Peng, PhD, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Avenue, Guangzhou 510000, Guangdong Province, China. 1015425249@qq.com
Received: June 4, 2026 Revised: July 16, 2026 Accepted: July 30, 2026 Published online: November 15, 2026 Processing time: 144 Days and 19.5 Hours
Abstract
BACKGROUND
The prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in cholangiocarcinoma (CCA) remains controversial largely due to varying cohort sizes across studies. Because CCA is characterized by marked anatomical heterogeneity, frequent biliary obstruction/cholangitis, and a distinct immunosuppressive microenvironment, the clinical interpretation of inflammatory biomarkers may differ from that in other solid tumors.
AIM
To comprehensively evaluate the prognostic significance of pretreatment NLR and PLR in CCA patients.
METHODS
PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched up to May 2026. Studies evaluating the association between pretreatment NLR/PLR and overall survival (OS) or disease-free survival in CCA were included. Because cut-off values differed across studies, pooled hazard ratios (HRs) were interpreted as aggregated comparisons between study-defined high and low groups rather than the effect of a single universal threshold. Pooled HRs and 95% confidence intervals (CIs) were calculated.
RESULTS
Based on a large-scale synthesis of 48 retrospective cohorts, elevated pretreatment NLR was significantly associated with poorer OS (pooled HR = 1.31, 95%CI: 1.22-1.41, P < 0.001) and disease-free survival. Similarly, high PLR was correlated with worse OS (HR = 1.14, 95%CI: 1.07-1.22, P < 0.001). Comprehensive subgroup analyses confirmed the prognostic stability of NLR across tumor types (intrahepatic CCA, extrahepatic CCA) and regions. Notably, NLR exerted a more profound negative impact on survival in patients receiving non-surgical/palliative therapies (HR = 1.73, 95%CI: 1.32-2.27) compared to those undergoing curative surgery (HR = 1.33, 95%CI: 1.18-1.50).
CONCLUSION
Elevated pretreatment NLR and PLR may be associated with poor prognosis in CCA. The pronounced impact of NLR in palliative settings highlights its potential value in risk stratification for unresectable patients. However, standardized cut-off values have not yet been established, and further prospective validation is required before these markers can be used as specific clinical decision-making criteria.
Core Tip: Pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio serve as significant prognostic biomarkers for cholangiocarcinoma. This meta-analysis of 48 cohorts confirms that elevated NLR and platelet-to-lymphocyte ratio correlate with poorer overall and disease-free survival. Notably, NLR demonstrates superior predictive value in patients receiving palliative therapy compared to those undergoing curative surgery. These findings suggest that NLR is a valuable tool for risk stratification in unresectable cases. However, the lack of standardized cut-off values necessitates cautious clinical application and further prospective validation before routine implementation.
