A Novel Inflammation-Based Stage (I Stage) Predicts Overall Survival of Patients with Nasopharyngeal Carcinoma

Abstract

Recent studies have indicated that inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS), modified GPS (mGPS) and C-reactive protein/Albumin (CRP/Alb) ratio, platelet–lymphocyte ratio (PLR), and neutrophil–lymphocyte ratio (NLR), have been reported to have prognostic value in patients with many types of cancer, including nasopharyngeal carcinoma (NPC). In this study, we proposed a novel inflammation-based stage, named I stage, for patients with NPC. A retrospective study of 409 newly-diagnosed cases of NPC was conducted. The prognostic factors (GPS, mGPS, CRP/Alb ratios, PLR, and NLR) were evaluated using univariate and multivariate analyses. Then, according to the results of the multivariate analyses, we proposed a I stage combination of independent risk factors (CRP/Alb ratio and PLR). The I stage was calculated as follows: patients with high levels of CRP/Alb ratio (>0.03) and PLR (>146.2) were defined as I2; patients with one or no abnormal values were defined as I1 or I0, respectively. The relationships between the I stage and clinicopathological variables and overall survival (OS) were evaluated. In addition, the discriminatory ability of the I stage with other inflammation-based prognostic scores was assessed using the AUCs (areas under the curves) analyzed by receiver operating characteristics (ROC) curves. The p value of <0.05 was considered to be significant. A total of 409 patients with NPC were enrolled in this study. Multivariate analyses revealed that only the CRP/Alb ratio (Hazard ratio (HR) = 2.093; 95% Confidence interval (CI): 1.222–3.587; p = 0.007) and PLR (HR: 2.003; 95% CI: 1.177–3.410; p = 0.010) were independent prognostic factors in patients with NPC. The five-year overall survival rates for patients with I0, I1, and I2 were 92.1% ± 2.9%, 83.3% ± 2.6%, and 63.1% ± 4.6%, respectively (p < 0.001). The I stage had a higher area under the curve value (0.670) compared with other systemic inflammation-based prognostic scores (p < 0.001). The I stage is a novel and useful predictive factor for OS in patients with NPC.

Neutrophil‐to‐lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta‐analysis

“…Data from 11 studies were synthesized in the meta‐analysis for NLR and OS in patients with head and neck cancer (Table ) . An elevated NLR value was found to be significantly associated with poorer OS with HR of 1.51 (95% CI 1.32‐1.73; P < .001).…”

“…The test for heterogeneity showed an I 2 value of 0%, P = .68, which represented no detectable heterogeneity. The forest plot and corresponding funnel plot are represented in Figure …”

“…The PRISMA flow chart of the systematic review can be found in Figure . An initial search done using the search strategy (Supporting Materials) obtained an initial 900 results.…”

“…We attempted contacting authors if the information in their article was not sufficiently detailed to be extracted, such as details on adjusted regression analysis, information on NLR cutoff, or the method of obtaining the cutoff . If the HR for OS was reported as an HR of a patient with NLR below a specific cutoff experiencing the endpoint of death (vs HR of a patient with NLR above a specific cutoff experiencing the endpoint of death), we took the reciprocal of the reported HR in order to make it comparable with the other studies …”

“…[48][49][50] If the HR for OS was reported as an HR of a patient with NLR below a specific cutoff experiencing the endpoint of death (vs HR of a patient with NLR above a specific cutoff experiencing the endpoint of death), we took the reciprocal of the reported HR in order to make it comparable with the other studies. 50,69,72,74…”