The prognostic value of the ratio of neutrophils to lymphocytes before and after intensity modulated radiotherapy for patients with nasopharyngeal carcinoma

Abstract

This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT). Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan–Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis. The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC. As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.

Meta-analysis and Critical Review: Association Between Radio-induced Lymphopenia and Overall Survival in Solid Cancers

“…From the group of studies without outliers, a subgroup analysis was performed based on the type of primary tumor. The studies were divided into 6 groups: Lung cancer, 17 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 glioblastoma, 44 , 45 , 46 , 47 pancreatic cancer, 19 48 49 head and neck cancer, 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 68 esophageal cancer, 30 43 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 and various. The various group included studies on cervical and endometrial cancer 68 , 69 , 70 hepatocellular carcinoma 71 , 72 , 73 , 74 and anal cancer 75 because each entity was represented <3 articles.…”

Systematic review and metanalysis of neutrophil to lymphocyte ratio and prognosis in patients with nasopharyngeal carcinoma

“…Table 2 shows the characteristics of the 14 included studies 21,29–41 . All were performed between 2012 and 2021, with study populations ranging in size from 62 to 1550 patients.…”

“…Table 2 shows the characteristics of the 14 included studies. 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 All were performed between 2012 and 2021, with study populations ranging in size from 62 to 1550 patients. Geographically, most of the studies were from China, 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 whereas the other three were from Thailand, 21 Singapore, 35 and Turkey.…”

“… 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 All were performed between 2012 and 2021, with study populations ranging in size from 62 to 1550 patients. Geographically, most of the studies were from China, 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 whereas the other three were from Thailand, 21 Singapore, 35 and Turkey. 40 Therefore, most of the included patients belonged to the Chinese ethnic group.…”

“…The disease stages ranged from stage I to stage IV, and almost all patients were treated with intensity‐modulated radiotherapy (IMRT). All 14 studies reported OS, 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 and nine reported PFS. 30 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 In most studies, NLR cut‐offs were determined using receive operating characteristic (ROC) curves.…”