Predictive impact of C-reactive protein to albumin ratio for recurrent or metastatic head and neck squamous cell carcinoma receiving nivolumab

Abstract

Although the neutrophil to lymphocyte ratio (NLR) was reported to be a predictive biomarker for clinical outcomes in various types of cancer, including recurrent or metastatic head and neck cancer (R/M HNSCC) treated with nivolumab, the usefulness of the pretreatment C-reactive protein/albumin ratio (CAR) as a prognostic marker remains to be clarified. This study aimed to analyze the clinical usability of the CAR in comparison with that of the NLR. 46 R/M HNSCC patients treated with nivolumab were retrospectively analyzed. The optimal cutoff value for the CAR was calculated using receiver operating characteristic curve analysis. The optimal cutoff value for the CAR was set to 0.30. On multivariate analyses, a high CAR was significantly associated with poor overall survival (adjusted HR, 2.19; 95% CI, 1.42–3.47; p < 0.01) and progression-free survival (adjusted HR, 1.98; 95% CI, 1.38–2.80; p < 0.01). The overall response rate and disease control rate for the high CAR patients were lower than for the low CAR patients. The CAR had significantly higher area under the curve values than the NLR at 2 and 4 months. The pretreatment CAR might be an independent marker for prognosis and efficacy in R/M HNSCC patients treated with nivolumab.

Neutrophil‐to‐lymphocyte ratio as a prognostic marker for head and neck squamous cell carcinoma treated with immune checkpoint inhibitors: Meta‐analysis

“…We screened the titles and abstracts of these studies and identified 24 potentially eligible studies. The full‐text versions of these 24 studies were then inspected according to the exclusion criteria, with 14 studies involving 929 patients determined to be eligible for inclusion in the present study 5,13–24 (Table 1). Two studies 15,23 contained overlapping data.…”

“…The HRs for PFS were reported in eight studies, 5,16–18,20–23 Ho et al 16 included two cohorts with different treatments. Nine cohorts comprising 653 patients were included.…”

“…Newer data was used when the same outcome data was presented in both studies. Of these 14 studies, nine, 13–15,17,18,21,23–25 all of which were studies from Japan, investigated patients treated with nivolumab. Only two studies 17,21 were multicenter cohort studies, whereas the remaining twelve 5,13–16,18–20,22–25 were single‐center cohort studies.…”

“…Moreover, meta‐analyses of the prognostic impact of NLR in patients treated with ICIs have been published for some types of cancers 9–12 . However, only small‐scale cohort studies with inconsistent results have reported the association between the NLR and ICIs in HNSCC 5,13–25 …”

Head and Neck Squamous Cell Carcinoma in Elderly Patients: Role of Radiotherapy and Chemotherapy

“…[18]. Finally, other parameters could be included in the CGA, such as the inclusion of immune parameters (neutrophil-to-lymphocyte ratio, C-reactive protein to albumin ratio, and so on) [19,20]. In this regard, more recently, Zhou et al introduced a novel clinical signature to predict survival of elderly patients with oral squamous cell carcinoma that included hemoglobin level, BMI, and NLR [21].…”