Pre‑treatment neutrophil‑to‑lymphocyte ratio predicts survival in patients with laryngeal cancer

Abstract

An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poorer prognostic outcomes in numerous types of cancer. However, a small number of studies have demonstrated the prognostic role of NLR in patients with laryngeal cancer. The present study evaluated the association between NLR and survival outcomes in patients with laryngeal squamous cancer. All patients were scheduled for follow-up visits. The levels of cytokines from tumor tissues were analyzed by ELISA. A classification and regression tree (CART) was used to determine the optimal cutoff values of NLR. The clinical features and NLR were determined using Kaplan-Meier analysis and Cox regression to analyze the survival outcomes and associated risks. Of the total 654 patients, 70 patients (70/654; 10.7%) failed to receive follow-up. Blood and biochemical parameters, including NLR, platelet-to-lymphocyte ratio and albumin-to-globulin ratio were associated with clinical characteristics of the patients, with the exception of histologic grade. Only one node with NLR at 3.18 divided patients into different categories, according to CART analysis. Survival analysis demonstrated that NLR at cutoff values subdivided patients into different survival outcomes (P<0.001). Subsequent to adjustments for age and other clinical features, NLR was identified to be an independent prognostic factor for overall survival and progression-free survival (P<0.05). Increased levels of cytokines, including IL-6 and IL-8, in tumor tissues were associated with NLR values. In summary, pre-treatment NLR was associated with the prognostic outcomes for patients with laryngeal cancer, and may assist to establish prognostic factors for these patients.

Prognostic Significance of Peripheral T‐Cell Subsets in Laryngeal Squamous Cell Carcinoma

“…Wong et al also showed that patients with Stages III‐IV LSCC have a higher NLR than those with Stages I‐II lesions. Moreover, the prognostic significance of NLR in terms of both overall survival and progression‐free survival was also confirmed by multivariate analysis in a large cohort of 654 patients treated for LSCC …”

“…To the best of our knowledge, few investigations have considered this topic in the head and neck literature, with particular emphasis on LSCC . Our study aimed to investigate how the immune system might change in patients with LSCC compared to a control group of subjects treated for a nonneoplastic, noninflammatory disease, and to investigate a possible association with clinical‐pathological characteristics and prognosis.…”

Physical activity and laryngeal cancer

“…Vigorous, high-intensity physical exercise is always accompanied by an acute phase response, which is directly proportional to the intensity and duration of the physical effort, according to an exercise-dose-dependent manner (35)(36)(37). Since some proinflammatory conditions are associated with enhanced risk and faster progression of laryngeal cancer (38)(39)(40)(41), it is hence reasonable to envision that moderate PA would produce large benefits than high-intensity exercise. Finally, emerging evidence attests that recreational PA may reduce the risk of gastroesophageal reflux disease (42), which is, in turn, a risk factor for laryngeal carcinogenesis (43).…”

Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer

“…A couple of other studies on heterogenous populations of larynx cancer demonstrated elevated NLR to be associated with inferior OS and progression-free survival (PFS) which further reinforces the potential for NLR to be a cancer-specific marker for larynx cancer. 11 , 22 Another limitation of previous studies we overcome is the inclusion of numerous, possible confounding covariables in our modeling. Given the documented potential of NLR to serve as a marker for non-oncologic, inflammatory conditions and overall competing mortality risk, our inclusion of details such as diagnosis of COPD or hospitalization within the year prior to diagnosis try to overcome potential confounding and delineate NLR’s role as a cancer-specific or non-cancer-specific marker in this population.…”

“…The findings of increased NLR with increased T and N category disease in the general realm of head and neck cancer has been reported as well. 22 , 28 - 30 …”