Relation of baseline neutrophil-to-lymphocyte ratio to survival and toxicity in head and neck cancer patients treated with (chemo-) radiation

Abstract

BackgroundA high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumors. We investigated the prognostic value of NLR and PLR in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary or adjuvant (chemo)radiotherapy ((C)RT).MethodsA retrospective chart review of consecutive patients with HNSCC was performed. Neutrophil-to-lymphocyte ratio and PLR were computed using complete blood counts (CBCs) performed within 10 days before treatment start. The prognostic role of NLR and PLR was evaluated with univariable and multivariable Cox regression analyses adjusting for disease-specific prognostic factors. NLR and PLR were assessed as log-transformed continuous variables (log NLR and log PLR). Endpoints of interest were overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and acute toxicity.ResultsWe analyzed 186 patients treated from 2007 to 2010. Primary sites were oropharynx (45%), oral cavity (28%), hypopharynx (14%), and larynx (13%). Median follow-up was 49 months. Higher NLR was associated with OS (adjusted HR per 1 unit higher log NLR = 1.81 (1.16–2.81), p = 0.012), whereas no association could be shown with LRFS (HR = 1.49 (0,83-2,68), p = 0.182), DRFS (HR = 1.38 (0.65–3.22), p = 0.4), or acute toxicity grade ≥ 2. PLR was not associated with outcome, nor with toxicity.ConclusionOur data suggest that in HNSCC patients treated with primary or adjuvant (C)RT, NLR is an independent predictor of mortality, but not disease-specific outcomes or toxicity. Neutrophil-to-lymphocyte ratio is a readily available biomarker that could improve pre-treatment prognostication and may be used for risk-stratification.

A meta-analysis of the impact of neutrophil-to-lymphocyte ratio on treatment outcomes after radiotherapy for solid tumors

“…All articles were published after 2012 and analyzed OS as the primary endpoint. Analyses included PFS in 15 studies, [10,17–30] DFS in 11 studies, [16,17,31–37] DMFS in 8 studies, [19,23,27,30,38,39] DSS in 1 study, [23] and pathologic CR in 2 studies on preoperative CCRT. [25,40] The median NLR cut-off value was 3.1 (range 1.9–5.0).…”

Prognostic Nomograms in Oral Squamous Cell Carcinoma: The Negative Impact of Low Neutrophil to Lymphocyte Ratio

“…In our study, we analyzed NLR as a continuous variable using restricted cubic spline with four knots in order to avoid any loss of information about its influence on survival. So far, it has been mostly dichotomized using the receiver operating characteristic curve or the median, or even subdivided into tertiles; in a single, recent paper NLR was studied as a continuous variable after logarithmic transformation (29). In recent meta-analyses on the prognostic role of NLR in OSCC, its general interpretation as a bimodal prognostic factor was confirmed (the higher the value, the poorer the survival); cut-offs ranged from 1.77 to 5, but most were around 2.5 (30–32).…”

High systemic immune-inflammation index predicts poor prognosis in advanced lung adenocarcinoma patients treated with EGFR-TKIs

“…There have been several immune-inflammation based indicators, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) which can predict survival in many solid tumors. [5,6,7,8,9] The systemic immune-inflammation index (SII) is also a simple and inexpensive marker which has been reported to be predictive in the prognosis in colorectal cancer, [10] NSCLC, [11] ovarian cancer, [12] pancreatic cancer, [13] and hepatocellular carcinoma [14] . However, the prognostic value of SII in EGFR-Mutant advanced NSCLC patients treated with EGFR-TKI has been rarely reported.…”