Neutrophil-to-lymphocyte ratio in head and neck cancer

Abstract

Introduction: The neutrophil-to-lymphocyte ratio (NLR) is an index of systemic inflammatory burden in malignancy. An elevated NLR has been associated with poor prognosis in a number of cancer sites. We investigated its role in a cohort of patients with locally advanced head and neck cancer.

Methods: Eligible patients had primary mucosal squamous cell carcinoma treated with chemoradiotherapy and a minimum follow-up of 12 months (unless deceased). NLR was analysed as <5 vs. ≥5 and above and below the median. The primary endpoint was overall survival (OS) and secondary endpoints metastasis free survival and locoregional relapse free survival. Actuarial Kaplan-Meier statistics and log rank test were used. Univariate analysis for age (continuous), Eastern Cooperative Oncology Group performance status (0 vs. 1), gender (male vs. female), smoking (yes vs. no), American Joint Committee on Cancer stage (III vs. IV) and NLR (<5 vs. ≥5 and <3.3 vs. ≥3.3) were performed.

Results: Forty-six patients were included in this analysis. Median NLR was 3.3 (0.4-22.8). After a median follow-up of 34 months (13-47 months), the 2-year estimated OS, metastasis free survival and locoregional relapse free survival for NLR <5 vs. ≥5 were 89% vs. 61% (p = 0.017), 84% vs. 64% (p = 0.083) and 81% vs. 70% (p = 0.17) respectively. On univariate analysis NLR ≥5 (p = 0.025), older age (p = 0.01) and ECOG 1 (p = 0.025) were significant for OS.

Conclusion: In this cohort of locally advanced head and neck cancer patients treated with chemoradiotherapy, pre-treatment NLR ≥5 was prognostic for mortality. Further studies are required to confirm these results and to assess the interaction with other prognostic factors.

Keywords: NLR; head and neck cancer; inflammation; neutrophil-to-lymphocyte ratio; radiotherapy.