Neutrophil/Lymphocyte Ratio and Prognosis in Patients with Non-Metastatic Nasopharyngeal Cancer: A Single-Center Experience

Abstract

Nasopharyngeal cancer's presentation and prognosis are variable. Even patients with the same clinical stage can have very different prognoses. The aim of the present study was to investigate clinical outcomes and prognosis, especially the effects of neutrophil/lymphocyte ratio (NLR), of non-metastatic nasopharyngeal carcinoma (NPC) in patients receiving radiotherapy (RT)±chemotherapy (CT) between March 2006 and August 2017 in the Eskişehir Osmangazi University Medical Faculty of Radiation Oncology Department. METHODS Sixty-two patients with non-metastatic NPC treated with RT±CT were retrospectively evaluated. Patient characteristics, such as age, gender, Karnofsky Performance Status (KPS), T phase, N phase, tumor, lymph node, and metastasis phase, histopathologic subgroup, tumor size, NLR, and hemoglobin value, and treatment characteristics, such as concurrent/adjuvant CT status, RT intermission time, and RT total time, were investigated. RESULTS Median overall survival (OS) was 55 (10-134) months, whereas median disease-free survival was 44 (6-129) months. The median duration of local control was 48 (6-129) months. Eleven (17.7%) patients developed distant metastases. Distant metastases were detected in 6 (9.7%) patients who had local control. Statistically significant results were obtained between general survival and sex (p=0.015), KPS (p<0.001), and NLR (p<0.001). Distant metastases were found to be significantly higher in male cases, and all 11 metastatic cases were male (Fisher's exact test, p=0.012). CONCLUSION Patients with high NLR had lower OS, and pretreatment NLR value may be a guide in determining which patients should receive more aggressive treatment.

Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

“…Among the 64 studies on non-TNM factors, 18 proposed parameters were identified. Prognostic factors with consistent support from multiple studies included EBV-DNA level ( Table 3 ), primary gross tumor volume (GTV) ( 63 , 72 – 74 , 76 , 78 – 81 ), nodal GTV ( Table 4 ) ( 74 , 75 , 77 , 81 ), neutrophil-lymphocyte ratio (NLR) ( Table 5 ) ( 83 , 85 , 91 , 92 , 97 ), C-reactive protein (CRP)/albumin ratio ( 83 , 89 , 98 ), anemia ( 84 , 87 , 96 ), platelet count ( 82 , 86 ), lactate dehydrogenase (LDH) ( 88 , 95 ), and SUV max of the primary tumor ( 99 – 101 , 103 , 108 , 111 , 113 ) and total lesion glycolysis (TLG) ( Table 6 ) ( 104 , 111 ).…”

“…In the 18 studies that were included, nine inflammatory/hematological markers were evaluated: the most frequently proposed marker (n = 5) is NLR ( 83 , 85 , 91 , 92 , 97 ), followed by anemia (n = 3) ( 84 , 87 , 96 ), LDH (n = 2) ( 88 , 95 ), platelet count (n = 2) ( 82 , 86 ), and the CRP/albumin ratio (n = 3) ( 83 , 89 , 98 ). Other proposals with limited supporting evidence included high-sensitivity CRP (hs-CRP; n = 1) ( 54 ), platelet distribution width (PDW) ( 86 ), prognostic nutrition index (PNI) and albumin/globulin ratio (AGR) (n = 1) ( 93 ), D-dimer (n = 1) ( 94 ), and tumor-infiltrating lymphocytes (TIL; n = 1) ( 90 ).…”

“…The results of 2,225 NPC patients in five studies showed that elevated pretreatment NLR was consistently associated with worse OS (HR 1.19–2.38), DMFS (HR 1.45), and LRFS (HR 1.35) ( Supplementary Table 5 ) ( 83 , 85 , 91 , 92 , 97 ). Evidence suggested that proinflammatory tumor microenvironments are closely related to cancer development and progression.…”

“…In the 18 studies that were included, nine inflammatory/ hematological markers were evaluated: the most frequently 5) (83,85,91,92,97). Evidence suggested that proinflammatory tumor microenvironments are closely related to cancer development and progression.…”

Systematic review and metanalysis of neutrophil to lymphocyte ratio and prognosis in patients with nasopharyngeal carcinoma

“…Table 2 shows the characteristics of the 14 included studies 21,29–41 . All were performed between 2012 and 2021, with study populations ranging in size from 62 to 1550 patients.…”