Neutrophil‐to‐lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta‐analysis

Tham, Tristan; Bardash, Yonatan; Herman, Saori Wendy; Costantino, Peter D.

doi:10.1002/hed.25324

Cited by 63 publications

(70 citation statements)

References 88 publications

(210 reference statements)

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“…It has been shown in several studies that PBLs predict oncological outcomes in various tumor models, including OSCC. [9][10][11][12][13][14][15][16][17][18][19][20] However, these biomarkers have not gained acceptance for routine use in preoperative prognostication.…”

Section: Discussionmentioning

confidence: 99%

“…The most analyzed parameters in the literature are the pretreatment absolute count of neutrophils, monocytes, and lymphocytes, as well as the ratio between neutrophils and lymphocytes (neutrophil‐to‐lymphocyte ratio; NLR). These have been reported to be strong predictors of outcomes in a wide range of tumor models, including head and neck tumors . Moreover, to integrate the influence of all these variables, Qi et al have recently proposed an index called Systemic Inflammation Response Index (SIRI), which combines all the leukocytes of interest (neutrophils, monocytes, and lymphocytes), showing that it has prognostic capacity in pancreatic cancer …”

Section: Introductionmentioning

confidence: 99%

“…These have been reported to be strong predictors of outcomes in a wide range of tumor models, including head and neck tumors. [9][10][11][12][13][14][15][16][17][18][19][20] Moreover, to integrate the influence of all these variables, Qi et al have recently proposed an index called Systemic Inflammation Response Index (SIRI), which combines all the leukocytes of interest (neutrophils, monocytes, and lymphocytes), showing that it has prognostic capacity in pancreatic cancer. 21 Multiple studies have been published analyzing the prognostic capacity of pretreatment peripheral blood leukocytes (PBLs) using different cutoffs found using different methods.…”

Section: Introductionmentioning

confidence: 99%

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Pretreatment peripheral blood leukocytes are independent predictors of survival in oral cavity cancer

Valero

Zanoni

McGill

et al. 2019

Cancer

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Background Inflammation and immune surveillance evasion are cancer hallmarks. Peripheral blood leukocytes (PBLs) represent both. The aim of the current study was to examine PBLs as predictors of outcomes in oral cavity squamous cell carcinoma (OSCC), and to find specific cutoffs with the goal of including PBLs as host factor in patients' preoperative risk assessment. Methods Previously established head and neck squamous cell carcinoma (HNSCC) cutoffs were examined in an independent cohort of 1369 OSCC patients. Then optimal OSCC cutoffs were found and validated in the subset of patients with OSCC (n = 119) from the external HNSCC cohort. The PBLs analyzed were neutrophils, monocytes, and lymphocytes individually, the neutrophil‐to‐lymphocyte ratio (NLR), and a combined index using all PBLs called Systemic Inflammation Response Index (SIRI). Results All parameters were significant predictors of survival using the previous cutoffs. However, OSCC cutoffs stratified survival outcomes better. Considering neutrophils ≤4.8 × 109/L as reference, patients with 4.8–9.1 × 109/L neutrophils had 1.536 times higher risk of death (95% CI, 1.295‐1.822), and patients with ≥9.1 × 109/L had 3.076 times higher risk (95% CI: 2.170‐4.360). All PBLs maintained independent prognostic capacity in multivariable analysis. Neutrophils, NLR, and SIRI were significant predictors of survival when validating OSCC cutoffs in the external validation cohort. Conclusions Pretreatment peripheral blood neutrophils, NLR, and SIRI are the most robust independent predictors of overall survival among all PBLs in OSCC. The authors report externally validated cutoffs that demonstrate the feasibility of including PBLs as host features in the preoperative prognostication of OSCC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pretreatment peripheral blood leukocytes are independent predictors of survival in oral cavity cancer

Valero

Zanoni

McGill

et al. 2019

Cancer

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“…All these hematological parameters indicative of an inflammatory status and failure of the immune system have been combined in order to obtain new prognostic biomarkers, such as the neutrophil‐to‐lymphocyte ratio (NLR), the platelet‐to‐lymphocyte ratio (PLR), the lymphocyte‐to‐monocyte ratio (LMR), or the Glasgow Prognostic Score (GPS), calculated with the C‐reactive protein and albumin levels …”

Section: Introductionmentioning

confidence: 99%

Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma

et al. 2019

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Background: Inflammation and immune evasion are associated with carcinogenesis. Systemic Inflammation Response Index (SIRI) has been proposed as a pretreatment peripheral blood biomarker. The aim of this study is to analyze its prognostic capacity in head and neck squamous cell carcinomas (HNSCC). Methods: We performed a retrospective study in 824 patients with HNSCC. SIRI was calculated by neutrophils*monocytes/lymphocytes. Using a recursivepartitioning analysis considering disease-specific survival (DSS) as dependent variable, three categories were defined according to SIRI value. Results: Males, patients with history of toxic consumption, oropharyngeal or hypopharyngeal tumors, and advanced tumors had a significantly higher SIRI value. As SIRI increased, a significant decrease in DSS was observed. In a multivariable analysis, SIRI was an independent predictor of DSS. Moreover, SIRI was a significant predictor of local, regional, and distant recurrence-free survival. Conclusions: SIRI has independent prognostic capacity in HNSCC. Patients with higher SIRI have a significant decrease in DSS.

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“…Enhancement of neutrophil infiltration by tumor cells has been reported to promote tumor growth and progression through remodeling of the extracellular matrix and activation of inflammatory markers, whereas lymphocyte infiltration is thought to be associated with control of cancer progression, especially when T4 helper and T8 suppressor lymphocytes are involved . Not surprisingly, a high NLR has been shown to be a significant predictive factor for survival in patients with cancer, including solid neoplasms such as head and neck cancer …”

Section: Discussionmentioning

confidence: 99%

Anemia and neutrophil‐to‐lymphocyte ratio in laryngeal cancer treated with induction chemotherapy

et al. 2019

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Objectives/Hypothesis We studied the influence of the neutrophil‐to‐lymphocyte ratio (NLR) and anemia on the response to induction chemotherapy (IC) and survival outcomes in laryngeal cancer patients treated with a preservation protocol. Study Design Retrospective single‐center case series. Methods We analyzed patients with T3 laryngeal cancer treated with IC using a preservation protocol. The NLR and hemoglobin levels were assessed before treatment and after IC. The response to chemotherapy was assessed using Response Evaluation Criteria in Solid Tumours 1.1 and World Heath Organization standards. The oncological endpoints were overall survival (OS) and disease‐free survival (DFS). Results Sixty‐eight patients were analyzed. The median NLR and hemoglobin levels before and after IC were 2.76 and 14.5 g/dL, and 2.01 and 11.6 g/dL, respectively. The NLR and anemia before treatment were not correlated, and they were not associated with the response to chemotherapy. However, an NLR > 5 and anemia before treatment were both associated with shorter OS and DFS. Notably, they were the only factors found to be significantly associated with survival outcomes. Conclusions In laryngeal cancer, patients treated with a preservation protocol, a high NLR ratio, and anemia before IC were associated with shorter survival, independently of the response to chemotherapy. Level of Evidence 4 Laryngoscope, 130:E144–E150, 2020

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Neutrophil‐to‐lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta‐analysis

Abstract: An elevated pretreatment NLR is a prognostic marker for head and neck cancer. It represents a simple and easily obtained marker that could be used to stratify groups of high-risk patients who might benefit from adjuvant therapy.

Cited by 63 publications

References 88 publications

Pretreatment peripheral blood leukocytes are independent predictors of survival in oral cavity cancer

Pretreatment peripheral blood leukocytes are independent predictors of survival in oral cavity cancer

Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma

Anemia and neutrophil‐to‐lymphocyte ratio in laryngeal cancer treated with induction chemotherapy

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