Advanced lung cancer inflammation index and its prognostic value in HPV-negative head and neck squamous cell carcinoma: a multicentre study

Piergiorgio Gaudioso,Vittorio Giacomarra,Anna Menegaldo,Margherita Tofanelli,Fiordaliso Cragnolini,Jonathan Fussey,Simone Mauramati,Mantegh Sethi,Gabriele Molteni,Andrea Ciorba,Paolo Bossi,Giancarlo Tirelli,Stefano Pelucchi,Daniele Borsetto,Jerry Polesel,Daniele Marchioni,Chiara Bianchini,Roberto Di Carlo,Marco Benazzo,Piero Nicolai,Cristoforo Fabbris,Paolo Boscolo‐Rizzo

doi:10.1007/s00520-020-05979-9

Abstract

PurposeThe aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment.MethodsThe present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM).ResultsTwo hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI < 20.4 (HR 3.23, CI 1.51–6.90 for PFS and HR 3.41, CI 1.47–7.91 for OS). Similarly, PNI < 40.5 (HR = 2.43, 95% CI: 1.31–4.51 for PFS and HR = 2.40, 95% CI: 1.19–4.82 for OS) and SIM > 2.5 (HR = 2.51, 95% CI: 1.23–5.10 for PFS and HR = 2.60, 95% CI: 1.19–5.67 for OS) were found to be significant predictors. Among the three indices, ALI < 20.4 identified the patients with the worst 5-year outcomes. Moreover, patients with a combination of low PNI and low ALI resulted to be a better predictor of progression (HR = 5.26, 95% CI: 2.01–13.73) and death (HR = 5.68, 95% CI: 1.92–16.79) than low ALI and low PNI considered alone.ConclusionsOur results support the use of pre-treatment ALI, an easily measurable inflammatory/nutritional index, in daily clinical practice to improve prognostic stratification in surgically treated HPV-negative HNSCC.

Highlights

The role of the inflammatory system and immunity in head and neck squamous cell carcinoma (HNSCC) tumorigenesis has been the subject of intense interest among researchers, with the focus being primarily on tumor infiltrating immune cells (TIICs) and immunoediting mechanisms [1, 2]
The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment, and to compare its prediction accuracy with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM)
Negative surgical margins were achieved in patients (78.9%) and extracapsular extension was absent in patients (89.4%)

Summary

Introduction

The role of the inflammatory system and immunity in head and neck squamous cell carcinoma (HNSCC) tumorigenesis has been the subject of intense interest among researchers, with the focus being primarily on tumor infiltrating immune cells (TIICs) and immunoediting mechanisms [1, 2].Several subtypes of TIICs have been observed to be associated with HNSCC prognosis and treatment response [3]. Evidence for specific mechanisms are emerging, for example the description of raised granulocyte-colony stimulating factor (G-CSF) in tumor development and consequent bone marrow reprogramming, with activation of a myeloid differentiation program in the early hematopoietic compartment, and an expansion of T cell-suppressive myeloid cells [8]. These mechanisms are yet to be fully understood, their possible clinical implications are significant, as evidenced by the finding that lower lymphocyte and higher platelet, neutrophil, and monocyte counts are associated with poor prognosis [9]

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