Neutrophil-to-lymphocyte Ratio: A Surrogate Marker for Prognosis of Oral Squamous Cell Carcinoma

Abstract

Context: Recent studies show that enzymatic contents of the neutrophil granules have a remarkable ability to modulate the tumor microenvironment by causing apoptosis of T-lymphocytes which leaves the host's cell-mediated immunity at stake. The preoperative neutrophil to lymphocyte ratio (NLR) is considered to be an indicator of the immune status of the patients with oral squamous cell carcinoma (OSCC), which will thereby help in predicting the course of the disease. Aims: The aim is to assess the NLR and histopathological prognostic factors pertinent to infiltration of the surrounding structures and correlate them with the clinical prognostic outcomes of OSCC. Settings and Design: This retrospective study involved the retrieval of formalin-fixed, paraffin-embedded, hematoxylin, and eosin-stained sections of 55 cases of OSCC from the departmental archives from 2006 to 2014. Subjects and Methods: Grading of each case was done by Bryne's grading system. The preoperative complete blood counts, relevant case history, and clinical data of the patients involved in the study were collected from the institutional medical records. The NLR was calculated by dividing the serum neutrophil count by the serum lymphocyte count. Statistical Analysis Used: The median NLR was compared between the controls and OSCC cases using Wilcoxon-signed rank test, and the Kaplan-Meier survival analysis was carried out to predict the survival and recurrence status of OSCC. Results: Higher NLR was seen in lymph node and margin-involved cases and also in patients who had tumor recurrence. Kaplan-Meier survival analysis showed that the mean survival dropped from 26 to 4.5 months when NLR ≥5 ( P = 0.052). Conclusion: Neutrophil-to-lymphocyte ratio can be used as a prognosticator of survival, recurrence, lymph node status, and margin status in OSCC.

Salivary Neutrophil-to-Lymphocyte Ratio as a Prognostic Predictor of Oral Premalignant and Malignant Disorders: A Prospective Study

“…The mean NLR value in patients who developed OSCC was 5.03±1.09, compared to 1.63±0.36 in patients who showed complete remission during an average follow-up period of one year. Though previous studies have reported a similar finding with an increase in NLR values in OSCC, compared to normal individuals, however, they reported lower values of 2.7-2.84 in OSCC patients [ 21 , 22 ]. This difference in NLR values could be due to the fact that they estimated NLR values in the blood samples of the patients, and in the present study it was estimated in the salivary samples.…”

Comparative evaluation of serum interleukin 6 with neutrophil - lymphocyte and platelet -lymphocyte ratio in pre and post-surgery oral squamous cell carcinoma.

“…It is a well-known prognostic indicator of HNC. 32 A study by Mahalakshmi et al 33 reported the mean range of NLR as 1.7-2.3 in healthy individuals of a similar population.…”

Haematological Parameters and Their Significance in Predicting Severity in Terms of Tumor Grade in Patients With Oral Squamous Cell Carcinoma

“…This can help in predicting the prognosis of the disease [22]. A study showed that NLR was found to be increased in poorer grades of tumor with poorly differentiated cases having a median of 2.9 [23]. Fang et al [24] also analyzed the data taken from OSCC patients and reported a significant correlation of elevated NLR with pathological stage and tumor depth along with disease-free and overall survival.…”