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This systematic review and meta\u2010analysis aimed to evaluate the relationship between pretreatment NLR and TANs and survival outcomes in patients with HNSCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The systematic literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Studies that documented pretreatment NLR in peripheral blood or TANs and their association with disease\u2010specific survival (DSS), progression\u2010free survival (PFS), overall survival (OS), disease\u2010free survival (DFS), and recurrence\u2010free survival (RFS) were included. Meta\u2010analyses were performed using the R \u201cmeta\u201d package. Subgroup analyses were performed based on tumor site and NLR thresholds. Heterogeneity was assessed using Cochran's Q and Higgins' I\n                      <jats:sup>2<\/jats:sup>\n                      statistics, while publication bias was evaluated using Egger's test and funnel plots.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 100 studies comprising 26\u2009324 patients were included. The hazard ratios (HR) for OS, PFS, DFS, DSS, and RFS were 1.88, 1.95, 1.85, 2.16, and 1.11, respectively, in univariate analysis. Multivariate analysis supported these findings and showed similar trends. Subgroup analyses indicated that high NLR consistently predicted poor OS across all studied tumor sites and NLR thresholds. Elevated densities of TANs, particularly CD15\n                      <jats:sup>+<\/jats:sup>\n                      and CXCR4\n                      <jats:sup>+<\/jats:sup>\n                      subsets, were linked to poorer cancer\u2010specific survival and OS, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta\u2010analysis indicates that elevated pretreatment NLR, particularly above four, may serve as a significant prognostic marker of poor survival outcomes in patients with HNSCC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jop.70110","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T14:01:37Z","timestamp":1767103297000},"page":"458-472","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Significance of the Pretreatment Neutrophil\u2010to\u2010Lymphocyte Ratio and Tumor\u2010Associated Neutrophils in Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9297-4157","authenticated-orcid":false,"given":"Ahana Kapuge Dona Varuni Yashodha","family":"Ratnayake","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases Clinicum, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2708-0712","authenticated-orcid":false,"given":"Aini","family":"Hyyti\u00e4inen","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases Clinicum, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia Vasiliki","family":"Gkountana","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases Clinicum, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7286-8031","authenticated-orcid":false,"given":"Meri","family":"Torri","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases Clinicum, University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Al\u2010Samadi","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases Clinicum, University of Helsinki  Helsinki Finland"},{"name":"Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland  Kuopio 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