Inflammation-based Prognostic Score as a Prognostic Biomarker in Patients With Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma Treated With Nivolumab Therapy

Abstract

Background/Aim: The inflammation-based prognostic score (IBPS) has attracted attention recently as a prognostic biomarker for head and neck cancer patients. However, as the IBPS often changes after anticancer drug therapy, its independent prognostic value remains controversial. We aimed to investigate the relationship between the IBPS and prognosis in recurrent and/or metastatic head and neck squamous cell carcinoma (RMHNSCC) treated with nivolumab, and investigate changes in the IBPS before and after nivolumab treatment. Patients and Methods: Total of 164 patients with RMHNSCC received nivolumab therapy were retrospectively analyzed. Results: Univariate analysis among the 164 patients revealed that the performance status (PS), immune-related adverse event (irAE) status, pre-and post-therapy Glasgow Prognostic Score (GPS), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), plateletto-lymphocyte ratio (PLR), and post-eosinophil count, were all significant predictors of overall survival (OS) (p<0.05). A multivariate analysis revealed that PS, irAEs, post-GPS, post-NLR, post-CAR, and post-eosinophil count were independent prognostic factors for overall survival. Conclusion: Post-treatment factors were identified as independent prognostic factors for RMHNSCC and can more accurately predict prognosis compared to nivolumab-treated RMHNSCC pre-treatment factors.

Pretreatment Glasgow Prognostic Score Correlated with Serum Histidine Level and Three-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma and Optimal Performance Status

“…In this context, GPS offers two advantages in clinical practice: ease of use with low cost and simultaneous reflection of the systematic nutritional and inflammatory status of patients with cancer [ 60 ]. In partial accordance with previous reports [ 22 , 23 , 24 , 25 , 26 ], our data found that patients with cancer and advanced GPS status were older, showed more betel quid use, and had decreased Hb levels, nutritional index (albumin, prealbumin, transferrin, and PNI), muscle mass, and histidine levels but higher levels of inflammatory markers (NLR and CRP), indicating a correlation between GPS, nutrition, and inflammation. Using the multivariate analysis that included all the possible confounding covariates, we further confirmed that advanced GPS outperformed other variables and was the sole prognostic factor for the 3-year mortality rate of patients with LAHNSCC ( Table 3 ).…”

“…These include old age [ 14 ], comorbidity [ 14 , 15 ], poor performance status [ 13 , 14 ], low body mass index (BMI) and body weight (BW) [ 13 , 14 , 16 ], anemia [ 14 , 15 ], low total lymphocyte count [ 13 ], low prognostic nutritional index (PNI) [ 17 ], high levels of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) [ 18 , 19 , 20 ], and total muscle and fat mass [ 19 , 21 ]. In particular, the Glasgow prognostic score (GPS), an inflammation-based model that combines the levels of serum albumin and CRP, has demonstrated significance for predicting outcomes in patients with HNC under different clinical circumstances [ 22 , 23 , 24 , 25 , 26 ]. Patients with HNC or oropharyngeal squamous cell carcinoma who expressed a low pretreatment modified Glasgow prognostic score (mGPS) showed better survival outcomes than those who expressed a high mGPS [ 23 , 25 ].…”

“…The improved GPS subgroup of patients with LAHNSCC after concurrent chemoradiotherapy (CCRT) showed a tendency toward superior overall and recurrence-free survivals [ 22 ]. GPS status after nivolumab treatment was also identified as an independent prognostic factor for the overall survival of patients with recurrent/metastatic HNC [ 24 ]. The correlation between pretreatment GPS or mGPS status and overall survival has also been reported in patients with recurrent/metastatic HNC receiving nivolumab therapy [ 26 , 27 ].…”

“…Furthermore, a comprehensive analysis which includes all the possible confounding covariates among the published reports is lacking. Although poor performance status showed an independent contribution to prognostic outcomes as well as NIBs in some studies [ 24 , 26 , 27 ], the effect of clinicopathologic factors, NIBs, and body composition on the survival outcome of patients with HNC who have good performance status remains uncertain. Therefore, these results should be interpreted with caution before clinical application.…”

Inflammation-based Neutrophil-to-Lymphocyte Ratio(NLR) as a Prognostic Biomarker for Patients With High-Risk Neuroblastoma

“…It is well known that the systemic in ammatory response (SIR) may play a critical role in tumor progression ,occurrence and metastasis by altering the tumor microenvironment, promoting angiogenesis and tumor cell proliferation [7,8].The peripheral blood cell counts, such as neutrophils, lymphocytes, monocytes or platelets can re ect the patient's immune and in ammatory statuses, which are associated with prognosis in many malignant tumors [9,10]. Neutrophil-to-lymphocyte ratio (NLR) is well-known as a systemic in ammation biomarker for various solid cancers, which integrates two in ammatory cells and is easily accessed from blood routine test [11][12][13][14][15]. Previous studies have demonstrated that NLR can predict the prognosis of patients with a variety of solid cancers, such as oesophageal squamous cell carcinoma, hepatocellular carcinoma, breast cancer and so on [14,16,17].…”