Abstract
BackgroundA high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumors. We investigated the prognostic value of NLR and PLR in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary or adjuvant (chemo)radiotherapy ((C)RT).MethodsA retrospective chart review of consecutive patients with HNSCC was performed. Neutrophil-to-lymphocyte ratio and PLR were computed using complete blood counts (CBCs) performed within 10 days before treatment start. The prognostic role of NLR and PLR was evaluated with univariable and multivariable Cox regression analyses adjusting for disease-specific prognostic factors. NLR and PLR were assessed as log-transformed continuous variables (log NLR and log PLR). Endpoints of interest were overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and acute toxicity.ResultsWe analyzed 186 patients treated from 2007 to 2010. Primary sites were oropharynx (45%), oral cavity (28%), hypopharynx (14%), and larynx (13%). Median follow-up was 49 months. Higher NLR was associated with OS (adjusted HR per 1 unit higher log NLR = 1.81 (1.16–2.81), p = 0.012), whereas no association could be shown with LRFS (HR = 1.49 (0,83-2,68), p = 0.182), DRFS (HR = 1.38 (0.65–3.22), p = 0.4), or acute toxicity grade ≥ 2. PLR was not associated with outcome, nor with toxicity.ConclusionOur data suggest that in HNSCC patients treated with primary or adjuvant (C)RT, NLR is an independent predictor of mortality, but not disease-specific outcomes or toxicity. Neutrophil-to-lymphocyte ratio is a readily available biomarker that could improve pre-treatment prognostication and may be used for risk-stratification.
Highlights
A high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumors
We retrospectively evaluated the prognostic impact of pretreatment NLR and PLR on oncological outcomes and toxicity in head and neck squamous cell carcinoma (HNSCC) patients treated with primary or adjuvant curative-intended radiotherapy ((C)RT)
We hypothesized that elevated NLR and/or PLR are associated with detrimental survival; we explored NRL and PLR associations with acute treatment-related toxicity since it has prognostic value in primary and adjuvant (C)RT for HNSCC [30, 31]
Summary
A high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumors. Neutrophil, lymphocyte, and platelet counts, either as individual values or in relation to each other, could be associated with the cancer prognosis [16, 17]. The neutrophil-to-lymphocyte ratio (NLR) is an emerging marker of host inflammation, which reflects the relation between circulating neutrophil and lymphocyte counts. It can be calculated from routine complete blood counts (CBCs) with differentiation. In addition to NLR, the platelet-to-lymphocyte ratio (PLR) has been shown to be a potential prognostic factor [2, 19]. Information about the possible value of pretreatment NLR or PLR on toxicity is limited [18,19,20,21,22,23,24,25,26,27,28,29]
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