Table 1_Prognostic value of the neutrophil-to-lymphocyte ratio in patients with colorectal cancer undergoing chemotherapy: a systematic review and meta-analysis.docx

Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and leave-one-out sensitivity analyses were performed.</p>Results<p>Thirty-eight studies (41 cohorts; 11,346 patients) were included. Elevated pretreatment NLR was associated with poorer OS (HR = 1.68, 95% CI 1.54–1.84; P < 0.0001) and poorer progression- or recurrence-related survival (HR = 1.61, 95% CI 1.43–1.81; P < 0.0001).

The direction of association was generally consistent across exploratory subgroups defined by treatment category, age, geographic region, and NLR cut-off. Leave-one-out analyses did not identify a single study that changed the direction of either pooled association. Between-study heterogeneity and evidence of small-study effects warrant cautious interpretation.</p>Conclusion<p>Elevated pretreatment NLR was associated with poorer survival outcomes in chemotherapy-treated CRC.

NLR may be a readily available prognostic biomarker, but heterogeneous populations, variable outcome definitions and cut-off values, inconsistent covariate adjustment, and possible small-study effects currently limit its use for clinical decision-making. Prospective validation and methodological standardization are required before routine application.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/, identifier CRD420251136904.</p>