Prognostic Value of Hematologic Markers in Head and Neck Squamous Cell Carcinoma

Abstract

The purpose of our study was to investigate the potential prognostic role of pretreatment hematologic markers, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiation therapy in our institution. We retrospectively analyzed medical records of 52 patients diagnosed with HNSCC and treated with definitive chemoradiation therapy between 2010 and 2015 at our institution. Demographic data, clinical stage, tumor characteristics and location, date of diagnosis, date of death, and baseline complete count blood were all collected. Pretreatment NLR and PLR were retrospectively calculated and investigated for correlation with overall survival (OS) using the Kaplan-Meier method. Univariate analysis for categorical and descriptive variables was also performed. A total of 52 patients with oral cavity (n=3, 5.8%), oropharyngeal (n=25, 48.1%), laryngeal (n=23, 44.2%), and hypopharingeal (n=1, 1.9%) cancer were included in this study. The mean age was 61.5 ± 9.1 years and the population was predominately male (82.7%). In the overall population, median OS (mOS) were 28 months. In univariate analysis, tumor stage (T2 vs T4a- T4b), nodal stage (N0 vs N2 or N3) and PLR were associated with improved OS (HR 1.003; 95% CI 1.001-1.005; P=.009). The median value of NLR was 3.239 (0.92-23.51) and PLR was 129.56 (51.42-817.93). Using median value as cutoff, NLR and PLR were significantly associated with OS. Patient with NLR > 3.239 had an mOS of 16 months, whereas the mOS for NLR ≤ 3.239 was 84 months (Log-rank P=.050). Patient with PLR > 129.56 had an mOS of 13 months, whereas the mOS for PLR ≤ 129.56 was 84 months (Log-rank P=.050). Using ROC curves, NLR and PLR were also associated with OS. PLR had the greatest area under the curve (AUC) of 0.739 (0.595-0.883; P=.004), and NLR had the AUC of 0.672 (0.506-0.838; P=.039). Our results indicate that pretreatment hematologic markers (NLR and PLR) are associated with prognosis in HNSCC patients treated with chemoradiation therapy, and represent a cost effective and easily measured marker for patient stratification. Further validation in prospective studies is needed, especially in context of immunotherapy.