Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for the Outcome of HPV-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma

Abstract

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in the past decades due to carcinogenic HPV infection. As this patient group suffers from considerable mortality and treatment morbidity it is important to improve prognostic strategies in OPSCC. Inflammation plays a key role in cancer and the neutrophil-to-lymphocyte ratio (NLR) in blood has been suggested as a prognostic factor for OPSCC. This study aimed to investigate the prognostic impact of NLR on overall survival (OS) and recurrence-free survival (RFS) in a retrospective cohort of 1370 patients. Included patients had pretreatment neutrophil and lymphocyte counts available, as well as a known HPV status. Patients were treated with curative intent according to Danish national guidelines. We stratified patients in groups by NLR < 2, NLR 2–4, or NLR > 4 and analyzed the influence of the NLR tertile on OS and RFS. Kaplan–Meier curves illustrated survival probability in OS and RFS in the general cohort and were stratified by HPV status. We found that an increasing NLR was associated with inferior OS (HR = 1.5 for NLR > 4) and RFS (HR = 1.6 for NLR 2–4; HR = 1.8 for NLR > 4) in multivariable analysis. The Kaplan–Meier curves displayed inferior OS and RFS with an increasing NLR for both HPV+ and HPV− patients. In conclusion, we showed that an increasing NLR is prognostic for a worse outcome of OPSCC independently of HPV status. There are possible uses of NLR in prognostication and treatment de-escalation although further studies are warranted to determine the clinical utility.

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).…”

A meta-analysis on first-trimester blood count parameters—is the neutrophil-to-lymphocyte ratio a potentially novel method for first-trimester preeclampsia screening?

“…Since inflammatory reactions are suggested behind the pathomechanism of preeclampsia ( 12 – 16 ) in recent years publications have been evaluating the role of white blood cells both in clinical studies and animal models in the prediction of preeclampsia ( 17 , 18 ). The distribution of white blood cells can be monitored through the neutrophil-to-lymphocyte ratio (NLR), which has been found to be a useful marker for inflammatory diseases such as systemic lupus erythematosus (SLE), spondyloarthritis, psoriasis, psoriatic arthritis, various types of tumors, and Takayasu arteritis (TA) ( 19 – 25 ). There have also been studies that evaluated the role of NLR in pregnancy-related diseases ( 26 , 27 ).…”

Predicting Potentially Fatal COVID-19 Disease in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio (NLR)

“…The NLR is typically measured from a complete blood count (CBC) or blood test [16]. The NLR was proven to be a valuable marker in assessing inflammatory conditions such as autoimmune diseases and different forms of cancer [17][18][19][20]. Given that COVID-19 is characterized by a significant inflammatory component [21], it is comprehensible why researchers examined the NLR as a potential prognostic marker, recognizing its role in predictive assessments.…”