Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer

Abstract

Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.

Quantitative Spatial Characterization of Lymph Node Tumor for N Stage Improvement of Nasopharyngeal Carcinoma Patients

“…Systematic inflammation indicators, which can be directly measured from blood test results, have been reported to be prognostic in multiple HNC subtypes. For example, pre-treatment neutrophil-to-lymphocyte ratio (NLR) has been investigated, and a strong statistical correlation was observed with positive neck occult metastasis in laryngeal squamous cell carcinoma [35]. Another study by Orabona et al confirmed the independent prognostic power of the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) on OS of patients who received malignant salivary gland tumor surgery [36].…”

Impact of Sarcopenia on Survival of Patients With Malignant Salivary Glands Tumors

“…For MSGTs, the literature has already widely discussed the topic and has identified the following as valid prognostic factors: tumor grading, lymph node involvement, positive resection margins, and TNM staging, with the latter representing the most effective prognostic factor 25 . However, as reported by several authors, patients with the same TNM stage may still display different disease progression 5‐12 …”

“…25 However, as reported by several authors, patients with the same TNM stage may still display different disease progression. [5][6][7][8][9][10][11][12] Hence, the need to identify early prognostic indicators, that can effectively and inexpensively predict disease progression, is paramount.…”

“…Pretreatment hematological markers have emerged as prognostic factors for several cancers, including head and neck cancer (HNC). [8][9][10][11][12] In a preliminary study, Abbate et al 13 have demonstrated the prognostic performance of a combination of hematological inflammatory biomarkers in MSGTs. Likewise, several authors have recently pointed out the prognostic value of patient nutritional status and sarcopenia in different cancers, including HNC.…”

Blood Markers Predicting Clinically Occult Lymph Node Metastasis in Head and Neck Squamous Cell Carcinoma

“…Moreover, immunological biomarkers for predicting prognostic information were provided, to facilitate clinical decision-making [12]. In spite of all the literature demonstrating the association between lymph node status and inflammatory indices (especially neutrophil-to-lymphocyte ratio [NLR]) [13,14], only a little evidence has described the association of NLR with pathological lymph node status in a population clinically N0, in oral and laryngeal cancer only [15][16][17][18]. To our knowledge, this focus on clinically occult metastases has never been replicated in the setting of oropharyngeal or hypopharyngeal HNSCC.…”