Abstract
Introduction and Aim: Cancer related inflammation is recognized as a critical multifaceted player in tumour initiation and progression. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important markers of systemic inflammatory burden in malignancy. The present retrospective study aimed to evaluate the prognostic value of pre-treatment baseline (NLR) and (PLR) for survival in HNC patients.
 
 Materials and Methods: Analysis of data of 257 patients with head and neck cancer treated with definitive therapy over 3.5 yrs. Neutrophil, lymphocyte and platelet counts before treatment of all patients were collected and NLR and PLR were calculated.
 
 Results: Median value of NLR and PLR were 3.7 and 170.63 respectively. Receiver operator characteristics (ROC) curve analysis showed the predictive cut-off value of NLR and PLR as 3.9 and 158.3. Univariate analysis using Cox-regression model showed NLR (p < 0.001) and PLR (p = 0.001) significantly influenced the locoregional recurrence free survival (LRRFS) and overall survival (OS). The multivariate analysis showed NLR is the independent prognostic factors influencing LRRFS (p = 0.007) and OS (p = 0.002). Kaplan-Meier survival curve (Log rank test; Chi-square (?2) value) showed OS is significantly influenced by NLR group (LRRFS; ?2 = 23.9 and OS; ?2 = 33.7) and PLR group (LRRFS; ?2 = 11.2 and OS; ?2 = 19.3) in contrast to LRRFS.
 
 Conclusion: NLR can be strongly used as biomarker for prognostication for outcome and survival in head neck cancer. However, a well-designed, larger studies with longer follow-up is warranted.
Highlights
Introduction and AimCancer related inflammation is recognized as a critical multifaceted player in tumour initiation and progression
neutrophil to lymphocyte ratio (NLR) can be strongly used as biomarker for prognostication for outcome and survival in head neck cancer
The results showed that the optimal predictive cut-off value of NLR is 3.9, at which most significant difference was observed in events
Summary
Cancer related inflammation is recognized as a critical multifaceted player in tumour initiation and progression. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important markers of systemic inflammatory burden in malignancy. The present retrospective study aimed to evaluate the prognostic value of pre-treatment baseline (NLR) and (PLR) for survival in HNC patients. Definitive chemo-radiotherapy is the main modality of treatment in locally advanced cancer but response varied depending upon both tumour characteristics and host related factors like age, sex, performance status etc., [2]. Various studies have showed close associations of systemic inflammation as an independent prognostic factor for treatment outcomes for many types of cancers, including colorectal cancer, renal cell cancer, pancreatic cancer, and head and neck squamous cell carcinoma [5]. An elevation of circulating neutrophil count is thought to be the result of tumour cells releasing cytokines, which stimulate the bone marrow to produce neutrophils [7]
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