Pretreatment neutrophil to lymphocyte ratio in determining the prognosis of head and neck cancer: a meta-analysis

Abstract

BackgroundRecent studies have reported a relationship between prognosis and neutrophil-to-lymphocyte ratio (NLR) in patients with head and neck cancer (HNC). As the results are still controversial, we conducted a meta-analysis of pretreatment NLR in peripheral blood and prognosis in HNC patients.MethodsWe retrieved articles from PubMed, Medline, Cochrane Library, Embase and Web of Science. A comparative analysis was conducted for the effect of pretreatment NLR in peripheral blood on overall survival (OS), progression-free survival, disease-free survival (DFS), disease-specific survival, metastasis-free survival, and recurrence-free survival of HNC patients. The analysis applied the criteria for systematic reviews described in the Cochrane Handbook and was conducted using hazard ratios (HRs) to estimate effect size, and calculated by Stata/SE version 13.0.ResultsThe meta-analysis included eligible cohort studies (5475 cases). The OS data indicated increased mortality risk in HNC patients with a high NLR (HR = 1.84, 95% confidence interval (CI): 1.53–2.23; P < 0.001; heterogeneity, I2 = 37.2%, P = 0.074). Analysis of subgroups stratified by NLR cutoff values revealed increased mortality risk and significantly shorter DFS in patients with high NLR compared to those with low NLR (HR = 2.18, 95% CI: 1.46–3.24; P < 0.001). Patients with high NLR had a higher probability of tumor recurrence after treatment than those with low NLR (HR = 1.63, 95% CI: 1.09–2.45; P = 0.017; heterogeneity, I2 = 68.7%; P = 0.022). The probability of distant metastasis following treatment was greater in patients with high compared with low NLR (HR = 1.92, 95% CI: 1.36–2.72; P < 0.001; heterogeneity, I2 = 0.0%; P = 0.614). Funnel plots of the meta-analysis results were stable, as shown by sensitivity analysis. No publication bias was detected by the Egger test (P = 0.135).ConclusionsHNC patients with elevated pretreatment NLR in peripheral blood have poor prognosis and are prone to local invasion and distant metastasis. NLR values are easily obtained from routinely collected blood samples and could assist clinicians to determine prognosis of HNC patients.

<p>Role of the pretreatment neutrophil-to-lymphocyte ratio in the survival of primary parotid cancer patients</p>

“…The NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count within 2 weeks before the initial treatment. [4][5][6][7][8][9][10][11][12][13][14] The cutoff value calculated from the ROC curve, mean, tertile, or median in previous studies varied from 1.98-5; 4-11 thus, the standard cutoff value remains unknown. In the current study, the cutoff value was defined as the mean value of the NLR.…”

“…[1][2][3] The peripheral neutrophil-to-lymphocyte ratio (NLR) is a well-known inflammatory marker. Several authors have previously reported that a high NLR is significantly associated with poor survival in solid cancers, [4][5][6][7][8][9][10][11][12][13][14] including head and neck squamous cell carcinoma and breast cancer. However, whether the NLR affects prognosis in patients with parotid cancer remains unknown; therefore, the current study aimed to clarify this question.…”

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

“…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 …”

“…[38][39][40][41][42] 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. 10,16,20,[43][44][45][46] Correlation with survival endpoints in laryngeal cancer patients has been investigated in a small number of studies (Table II), despite their anatomical and pathological specificities. [11][12][13]18,47,48 Karpathiou et al found an association between the NLR and induction chemotherapy in a series of 83 head and neck cancer patients, of whom only 11 had laryngeal cancer.…”

The Value of Inflammatory Parameters in the Differantial Diagnosis of “Benign” and “Malignant” Lesions in Parotid Gland Tumors

“…11 Yu ve ark.nın yaptığı bir metaanalizde ise yüksek NLR olan baş-boyun kanserli hastalarda lokal invazyon, uzak metastaz eğilimli olduğu ve kötü prognozu gösterdiği bildirilmektedir. 12 Eş zamanlı kemoradyoterapi ile tedavi edilen baş-boyun kanserlerinde, lenfosit/monosit oranının bağımsız bir prognostik faktör olabileceği görüşüne varılmıştır. 13 Çalışmamızda da NLR seviyesi benign lezyonlarda 1,84, malign tümörlerde 2,68 olarak tespit edilmiştir.…”