Neutrophil to Lymphocyte Ratio in Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Neutrophil-to-lymphocyte ratio (NLR) has been associated with survival in various cancers, including head and neck cancer. However, there is limited information on its role in oropharyngeal squamous cell carcinomas (OPSCC) according to HPV status. This prompted the present meta-analysis. Studies were selected when the prognostic value of NLR prior to treatment was evaluated in OPSCC patients, the cutoff value of NLR was available, and the prognostic value of NLR was evaluated by time-to-event survival analysis. A total of 14 out of 492 articles, including 7647 patients, were analyzed. The results showed a worse prognosis for the patients with a high NLR: The combined hazard ratios (HR) for overall survival (OS) in patients with an elevated NLR was 1.56 (95% confidence interval (CI) 1.21–2.02; p = 0.0006), for disease-free survival was 1.52 (95% CI 1.34–1.73; p < 0.00001), and for recurrence-free survival was 1.86 (95% CI 1.50–2.30; p < 0.00001). This worse prognosis of high NLR was exclusive of HPV-positive patients: HR for OS in the HPV-positive subgroup was 4.05 (95% CI 1.90–8.62 (p = 0.0003), and in the HPV-negative subgroup 0.92 (95% CI 0.47–1.80; p = 0.82). The prognosis of NLR was not influenced by treatment: The HR for OS for patients treated with radiotherapy/chemoradiotherapy (RT/CRT) was 1.48 (95% CI 1.09–2.01; p = 0.01), and for patients treated with surgery (±RT/CRT) was 1.72 (95% CI 1.08–2.72; p = 0.02). In conclusion, an elevated NLR relates to worse outcomes in patients with HPV-positive OPSCC.

The Prognostic Value of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio, and Monocyte–Lymphocyte Ratio in Head and Neck Squamous Cell Carcinoma (HNSCC)—A Retrospective Single Center Study and a Literature Review

“…NLR is the most frequently reported biomarker, and the meta-analysis of Rodrigo et al, which includes studies related to oropharyngeal cancer, identifies NLR, more precisely the increased values of this ratio, as a negative prognostic factor. Even though, regardless of HPV status, high pre-treatment NLR values were associated with an unfavorable prognosis in oropharyngeal cancer, the correlation of NLR with prognosis was more significant in cases of HPV-related oropharyngeal cancer [6].…”

The Neutrophil-to-Lymphocyte Ratio as a Biomarker in Cutaneous Oncology: A Systematic Review of Evidence beyond Malignant Melanoma

“…Finally, in a retrospective study of 21 patients with SCC of the auditory canal, most of them of the external auditory canal (EAC: n = 18; the rest n = 3 of middle ear), who received radiotherapy with or without surgery or systemic therapy, the OS differed significantly between patients with a high vs. low pretreatment NLR ( p = 0.037), suggesting that the NLR has a significant prognostic impact on treatment outcomes in patients with locally advanced SCC of the EAC [ 71 ]. Notably, convincing data also support a prognosticator role for the NLR in SCC arising on diverse extracutaneous localizations, including the oropharynx and head and neck regions [ 72 , 73 , 74 , 75 , 76 , 77 ], esophagus [ 78 , 79 , 80 ], and anus [ 81 , 82 ]. The above evidence, taken together, indicates that the NLR seems to be a reliable biomarker of disease aggressiveness (poorer progression-free survival and higher cancer specific mortality) in patients with SCC, including patients with cSCC [ 83 ].…”

Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives

“…FCER2 is an Fc receptor specific to IgE, upregulated on haemopoietic and B cells. Additionally, the pre-treatment neutrophil-to-lymphocyte (NLR) ratio in peripheral blood has been shown to inversely correlate with OS and DFS in HPV + OPSCC [ 143 , 144 , 145 ]. NLR is also an independent risk factor for severe disease [ 146 ] and neutrophilia is associated with increased expression of neutrophil extracellular traps (NETs).…”