Prognostic Value of Inflammatory Markers in Nasopharyngeal Carcinoma Patients in the Intensity-Modulated Radiotherapy Era

Abstract

Purpose: Inflammatory markers have been widely used in various cancers, but rarely in nasopharyngeal carcinoma (NPC). Here, we evaluated the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), systemic immune index (SII), and systemic inflammation response index (SIRI) on NPC in the intensitymodulated radiotherapy (IMRT) era. Methods: We retrospectively analyzed data from NPC patients from the Renmin Hospital of Wuhan University, between January 2012 and July 2020. We used Chi-square test or Fisher's exact test to compare the baseline characteristics, then applied Kaplan-Meier (K-M) survival analysis to compare the overall survival (OS) and progression-free survival (PFS) rates. Multivariate Cox proportional risk models were applied to identify independent prognostic factors. Results: We enrolled a total of 342 NPC patients and found optimal cut-off values of 2.65, 184.91, 804.08, and 1.34 for NLR, PLR, SII, and SIRI, respectively. K-M survival analysis revealed that high NLR, PLR, SII, and SIRI were significantly associated with worse OS and PFS relative to those in the low groups. Results from univariate Cox analysis showed that clinical, T, and M stages, as well as NLR, PLR, SII, and SIRI were associated with OS, whereas age, alongside the aforementioned parameters, was associated with PFS. Moreover, multivariate Cox analysis showed that age ≥49 years (HR=2.48, 95% CI=1.21-5.05, P=0.013) and M1 stage (HR=3.84, 95% CI=1.52-9.73, P=0.013) were independent prognostic factors for OS, whereas SIRI ≥1.34 (HR=1.91, 95% CI=1.05-3.47, P=0.034) and M1 stage (HR=2.91, 95% CI=1.44-5.86, P=0.003) were independent prognostic factors for PFS. Conclusion: Overall, our findings indicated that high NLR, PLR, SII, and SIRI were significantly associated with poor OS and PFS in NPC patients. High SIRI may be an independent risk factor for PFS of NPC patients in the IMRT era.

Prognostic Value of a Serum Panel of Inflammatory Factors in Non-Metastatic Nasopharyngeal Carcinoma Patients Undergoing Radical Radiotherapy with Adjuvant Chemotherapy

“… 8 , 13 The systemic immune-inflammation index (SII), another integrated index based on platelet count and NLR, has been shown to be associated with OS and PFS in NPC patients with an approximate AUC value of 0.6 for OS. 10 , 11 , 15 , 32 An elevated neutrophil to lymphocyte ratio (NLR) is associated with a lower survival rate and worse treatment response to chemotherapy with an AUC value of 0.619 for OS. 11 , 12 , 14 , 33 , 34 Li et al proposed an index combining the C-reactive protein to albumin ratio and platelet to lymphocyte ratio, resulting in an AUC value of 0.670 for OS prediction.…”

“… 10 , 11 , 15 , 32 An elevated neutrophil to lymphocyte ratio (NLR) is associated with a lower survival rate and worse treatment response to chemotherapy with an AUC value of 0.619 for OS. 11 , 12 , 14 , 33 , 34 Li et al proposed an index combining the C-reactive protein to albumin ratio and platelet to lymphocyte ratio, resulting in an AUC value of 0.670 for OS prediction. 35 One advantage of these studies is that indicators of routine clinical detection can be used.…”

“…6,7 NPC has a close relationship with Epstein-Barr virus (EBV) infection, and studies have shown that inflammation-based indices are associated with the prognosis of NPC patients. [8][9][10][11][12] However, most of these studies did not perform an analysis of receiver operating characteristic curves (ROCs), the area under which (or AUC) shows the exact prognostic value. Few studies have conducted ROC analysis, but the prognostic value of the indices used was not high, with AUC ranging from 0.6-0.8.…”

“…Few studies have conducted ROC analysis, but the prognostic value of the indices used was not high, with AUC ranging from 0.6-0.8. 10,11,[13][14][15] Therefore, it is worth searching for inflammatory factors with higher prognostic value. In addition, these studies selected baseline indicators as the predictors.…”

Prognostic significance of systemic immune-inflammation index in patients with nasopharyngeal carcinoma: a meta-analysis

“…Numerous studies have demonstrated that SII is related to the prognosis of solid tumors, such as hepatocellular carcinoma [ 11 ], esophageal squamous cell carcinoma [ 13 ], gastric cancer (GC) [ 14 ], pancreatic cancer [ 15 , 16 ], breast cancer [ 17 ], lung cancer [ 18 , 19 ], oral cancer [ 20 ], and other cancers. Several recent studies also showed the SII to b prognostic for NPC [ 21 – 26 ], although the results were inconsistent. For instance, in some studies [ 21 – 23 ], SII was reported as an independent prognostic factor for NPC; however, in other studies [ 24 – 26 ], SII was not documented as an independent prognostic factor for NPC.…”