Neutrophil-lymphocyte ratio associated with poor prognosis in oral cancer: a retrospective study

Abstract

Background: Prognostic biomarkers provide essential information about a patient's overall outcome. However, existing biomarkers are limited in terms of either sample collection, such as requiring tissue specimens, or the process, such as prolonged time for analysis. In view of the need for convenient and non-invasive prognostic biomarkers for oral cancer, we aimed to investigate the prognostic values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patient survival. We also aimed to explore the associations of these ratios with the clinicopathologic characteristics of Japanese oral squamous cell carcinoma patients. Methods: This study was a non-randomized retrospective cohort study in a tertiary referral center. We included 433 patients (246 men, 187 women) who underwent radical surgery for oral cancers between January 2001 and December 2013. We evaluated various risk factors for poor prognosis including neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio with univariate and multivariate analyses. The disease-specific survival and overall survival rates of patients were compared among the factors and biomarkers. Results: In multivariable Cox proportional hazards analysis, high neutrophil-to-lymphocyte ratio (hazard ratio 2.87, 95% confidence interval 1.59-5.19, P < 0.001), moderately or poorly differentiated histology (hazard ratio 2.37, 95% confidence interval 1.32-4.25, P < 0.001), and extranodal extension (hazard ratio 1.95, 95% confidence interval 1.13-3.35, P = 0.016) were independent predictors of disease-specific survival. High neutrophil-to-lymphocyte ratio (hazard ratio 2.30, 95% confidence interval 1.42-3.72, P < 0.001), moderately or poorly differentiated (hazard ratio 1.72, 95% confidence interval 1.07-2.76, P = 0.025), and extranodal extension (hazard ratio 1.79, 95% confidence interval 1.13-2.84, P = 0.013) were independent predictors of overall survival. Conclusions: Neutrophil-to-lymphocyte ratio might be a potential independent prognostic factor in Japanese oral squamous cell carcinoma patients.

Platelet to lymphocyte and neutrophil to lymphocyte ratios in endometrial pathologies

“…NLR is accepted as an effective and simple parameter of inflammation [13]. Starting from this point of view, NLR and prognosis association has been investigated in different types of cancer [14][15][16].…”

Prognostic Value of Preoperative Neutrophil-to -Lymphocyte Ratio in Adenoid Cystic Carcinoma of the Head and Neck

“…Higher neutrophil levels can upregulate the expression of growth factors, such as chemokines, which play an important role in tumor development and progression. The reduction in lymphocytes indicates that the body's immunity is reduced and its antitumor ability is weakened.An increased NLR indicates that the body's in ammatory response is increased, while the lymphocyte-mediated antitumor response is decreased, which can easily cause tumor deterioration and metastasis, ultimately leading to the poor prognosis of patients 15,16,17,23,24 .Takumi Hasegawa et al reported that the NLR increased with the number of pathological lymph node metastases and shorter OS in patients with oral cancer, which was also an indication of a decrease in the lymphocyte count 25 . The results of a meta-analysis suggested that an elevated pretreatment NLR is a negative prognostic factor in patients with head and neck cancer 26 .…”

Neutrophil-to-Lymphocyte Ratio (NLR) as An Inflammation Degree Marker in Tongue Cancer Patient

“…[29] Pada 16 artikel yang diteliti, sebanyak 11 artikel mengekslusikan faktor lain selain kanker yang dapat menyebabkan perubahan RNL seperti penyakit kronis lain dan autoimun. [12], [19]- [22], [24], [25], [27], [28], [30], [31] RNL digunakan sebagai penanda inflamasi sistemik memiliki nilai prognostik pada berbagai jenis kanker seperti kanker paru, hati, esofagus, gastric, kolorektal, dan pankreas. [12] Pada pasien kanker rongga mulut, nilai RNL yang meningkat berhubungan secara signifikan dengan penurunan overall survival (OS) dan dapat digunakan sebagai faktor prediktif untuk prognosis.…”

“…[12], [32], [35], [36] Artikel pada penelitian ini juga membahas mengenai hubungan nilai RNL dengan terjadinya metastasis ke nodus limfe atau klasifikasi N. RNL dapat menjadi faktor prediktif untuk delayed lymph nodes metastasis dan multiple lymph nodes metastasis dan nilai RNL yang tinggi diatas cut-off value dapat mengindikasikan terjadinya metastasis nodus limfe. [22], [34], [37] Penelitian yang meneliti perbedaan rata-rata nilai RNL pada pasien pN0 dan pN+, menyebutkan pasien pN+ memiliki rata-rata nilai RNL yang lebih tinggi dan nilai RNL 2.93 berkaitan dengan probabilitas terjadinya metastatis tersembunyi pada pasien cN0 [24]. Peningkatan nilai RNL sejalan dengan peningkatan histologic grading menuju moderate-poor differentiation menurut klasifikasi WHO.…”