Abstract
AimWe probed the prognostic value of the preoperative high-sensitivity modified Glasgow prognostic score (HS-mGPS), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) for patients with oral cavity squamous cell carcinoma (OSCC) to identify patients with the highest risk of having poor survival outcomes.Materials and MethodsWe executed a retrospective assessment of the records of 303 patients with OSCC who had been subjected to curative surgery between January 2008 and December 2017. The HS-mGPS was categorized using C-reactive protein and albumin thresholds of 3 mg/L and 35 g/L, respectively. Moreover, receiver operating characteristic curve analyses were executed to find out the optimal PLR and NLR cutoffs. We plotted survival curves and compared them through the use of the Kaplan–Meier method and log-rank test, respectively. Through a Cox proportional hazard model, we identified prognostic variables. We also plotted a nomogram comprising the HS-mGPS and clinicopathological factors and assessed its performance with the concordance index.ResultsThe PLR and NLR cutoffs were 119.34 and 4.51, respectively. We noted an HS-mGPS of 1−2 to be associated with a shorter median overall survival (OS) and disease-fee survival (DFS) compared with an HS-mGPS of 0. Multivariate analysis revealed that an HS-mGPS of 1−2 and an NLR of ≥4.51 were independent risk factors related to poor OS and DFS. The HS-mGPS appeared to have better prognostic effect than did the PLR and NLR, and the combination of the HS-mGPS and NLR appeared to exhibit optimal discriminative ability for OS prognostication. The nomogram based on the HS-mGPS and NLR yielded accurate OS prediction (concordance index = 0.803).ConclusionOur findings suggest that preoperative HS-mGPS is a promising prognostic biomarker of OSCC, and the nomogram comprising the HS-mGPS and NLR provided accurate individualized OSCC survival predictions.
Highlights
Oral cavity cancer is the commonest malignancy in the head and neck region
We further investigated the prognostic effect of the combinations of indices by adding the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), separately, to the HS-modified Glasgow prognostic score (mGPS); the results demonstrated that the combination of the high-sensitivity mGPS (HS-mGPS) and NLR had the highest predictive accuracy, prognostic stratification performance, and predictive homogeneity
We revealed that patients with a high NLR (≥ 4.51) and an HS-mGPS of 1−2 had the poorest overall survival (OS), suggesting that an HS-mGPS of 1−2 and NLR of ≥4.51 may indicate some synergism that contributes to a poor oral squamous cell carcinoma (OSCC) prognosis
Summary
Oral cavity cancer is the commonest malignancy in the head and neck region. Of malignant tumors in the oral cavity, 90% are categorized as oral squamous cell carcinoma (OSCC) [1]. The global OSCC incidence is increasing, with over 300,000 cases diagnosed in 2020 [2]. Despite the application of advanced diagnostic modalities and multidisciplinary management, the OSCC prognosis remains unsatisfactory, and approximately 40% of patients experience locoregional recurrence and distant metastasis [3]. The identification of practical biomarkers for OSCC prognosis would be of clinical value. Studies have reported that several molecular biomarkers related to cancer cell differentiation and proliferation, metastasis, and angiogenesis could be applied to enhance OSCC survival estimations [4]. The molecular biomarkers and costly laboratory techniques employed may not be widely applicable in clinical practice
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