The Role of Immunotherapy in Nasopharyngeal Carcinoma in the Future: Evidence from the Era of Conventional Radiotherapy

Abstract

Neutrophil to Lymphocyte Ratio (NLR) has demonstrated its promising potential as a prognostic biomarker in multiple cancer types. It is considered NLR is related to immunologic status. However, induction chemotherapy and the immune regulation drugs commonly alter NLR before radiotherapy, which might compromise the conclusion. The goal of the present study was to verify the predictive value of NLR in the absence of chemotherapy and immune regulation era NPC patients. In this retrospective study in the endemic region, we included 552 NPC patients from 1996 to 2002 with available pretreatment peripheral CBC data. Selected patients were treated with 2D conventional radiotherapy only. Optimal NLR cutoff was determined by receiver operating curve analysis, and the whole cohort was divided into high NLR and low NLR group based on the cutoff value. Kaplan Meier method and log-rank test were used to plot and compare survival, univariate and multivariate analysis were performed using Cox regression hazards model. 96% of the included patients were locally advanced or metastasized. The median value of NLR was 2.82(IQR, 1.94-4.56). With OS as the endpoint, NLR cutoff value was 2.29. It was discovered that NLR cutoff value was associated with T stage (p=0.036), and borderline associated with clinical stage (p=0.060). In multivariate analysis, compared with lower NLR group (≤2.29), the patients in higher NLR group (>2.29) was highly associated with worse overall survival (HR, 1.46; 95%CI, 1.14-1.85; p=0.002). For the first time in the exclusion of the hematological influence, this study verified the survival outcome was extremely related to the original status of immune before radiotherapy in NPC patients. Immunotherapy might play an essential role in the treatment of NPC in the future.