Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer.

Giovanni Salzano,Alessandro Ottaiano,Franco Ionna,Mario Balia,Michela Apolito,Ettore Pavone,Francesco Perri,Luigi Angelo Vaira,Giulia Togo,Vincenzo Abbate,Federica Calabria,Luigi Califano,Fabio Maglitto,Corrado Aversa,Francesco Antonio Salzano,Umberto Committeri,Mariachiara Santorsola,Marco Cascella,Claudia Laface,Roberta Fusco ,Gianluca Renato De Fazio

doi:10.3390/jpm11121252

Abstract

Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.

Highlights

The presence of cervical lymph node metastasis in Laryngeal Squamous Cell Carcinoma (LSCC) is notorious in negatively affecting the survival of patients [1]
All patients affected by LSCC, who had been surgically treated by means of laryngectomy and elective neck dissection (END) between January 2006 and January 2021, were retrospectively reviewed using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute
The inclusion criteria were as follows: (1) a histology-proven case of LSCC; (2) primary LSCC that had not been treated previously; (3) LSCC with no regional or distant metastasis detectable at presentation, clinically and/or radiographically (Neck Ultrasound, computed tomography (CT) and/or magnetic resonance imaging (MRI)); (4) no previous cancers at any other sites; (5) no radiotherapy or chemotherapy in the clinical history; (6) no clinical conditions that might affect the neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR); (7) a complete record of pretreatment hematological variables; and (8) treatment with a laryngectomy and an END at level II-IV

Summary

Introduction

The presence of cervical lymph node metastasis in Laryngeal Squamous Cell Carcinoma (LSCC) is notorious in negatively affecting the survival of patients [1]. The percentage of cervical metastasis is

Materials and Methods

Statistical Analysis

Results