Optimal cutoff of pretreatment neutrophil-to-lymphocyte ratio in head and neck cancer patients: a meta-analysis and validation study

Abstract

BackgroundThe prognostic role of neutrophil-to-lymphocyte ratio (NLR) has been proposed in head and neck squamous cell carcinoma (HNSCC). However, it is currently unclear which cutoff values of NLR could consistently and independently differentiate HNSCC patients to better and worse prognosis groups.MethodsWe performed a meta-analysis of prognostic significance of pretreatment NLR values, using data extracted from 24 relevant articles. Main outcomes were overall survival (OS) and disease-free survival (DFS) in HNSCC patients. Pooled hazard ratio (HR) and 95% confidence intervals (95%CI) were calculated using the random effect model for outcomes. Impacts of NLR cutoff values across the studies were assessed with a meta-regression analysis. Results were validated using an independent data set of patients (n = 540).ResultsPretreatment high NLR values above the cutoff were significantly associated with shorter OS (HR = 1.96, 95%CI = 1.66–2.31) and DFS (HR = 1.90, 95%CI = 1.41–2.54). Of note, NLR cutoffs ranging from 1.9 to 6.0 did not affect HR of OS or DFS in meta-regression analyses. In an independent cohort, any NLR cutoff between 2 and 6 produced significant HR of OS, similarly. Instead of binary cutoffs, three subgroups of NLR (< 2, 2 to 6, and ≥ 6) showed significant differences of OS in survival analyses.ConclusionsMeta-analyses confirmed that pretreatment NLR values above the cutoff were associated with shorter survival in HNSCC patients. However, the binary cutoffs of NLR values were variable across studies. Rather, pretreatment NLR values below 2 and above 6 using a three-tier classification (< 2, 2 to 6, and ≥ 6) could consistently imply better and worse prognosis in HNSCC patients, which could be readily translated to clinics.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4876-6) contains supplementary material, which is available to authorized users.

Pretreatment peripheral blood leukocytes are independent predictors of survival in oral cavity cancer

“…It follows that NLR cutoffs were higher in the OSCC cohort. Interestingly the NLR cutoffs were very similar to the optimal NLR cutoffs as defined by Cho et al (2 and 6 vs 2.9 and 5.7 in the current study, respectively) …”

“…The main challenge is to set the optimal cutoffs that can be used universally. To our knowledge, only Cho et al have tried to set the optimal cutoffs for HNSCC . The aim of the current study was to establish the utility of pretreatment PBLs as prognostic factors in OSCC and to find optimal cutoffs that can be translated to routine clinical use.…”

“…Interestingly the NLR cutoffs were very similar to the optimal NLR cutoffs as defined by Cho et al (2 and 6 vs 2.9 and 5.7 in the current study, respectively). 22 Finally, we validated the cutoffs identified in the test set (group A) using an independent subset of patients with OSCC (group B) from the previous study. Only neutrophils, NLR, and SIRI predicted outcomes in the validation cohort.…”

“…However, a limited number of studies aimed to validate Cancer March 1, 2020 established cutoffs or define universal cutoffs that can be used on a daily clinical basis when preoperatively assessing patient's risk for worse outcomes. 22 A previous study showed that higher pretreatment peripheral neutrophils, monocytes NLR, and lower lymphocytes are associated with worse outcomes in head and neck squamous cell carcinomas (HNSCC). 23 The previous cohort included patients treated both surgically and non-surgically and tumors from different head and neck sites, with a limited number of patients with oral cavity tumors (n = 119; 14.4%).…”

“…Multiple studies have been published analyzing the prognostic capacity of pretreatment peripheral blood leukocytes (PBLs) using different cutoffs found using different methods. However, a limited number of studies aimed to validate established cutoffs or define universal cutoffs that can be used on a daily clinical basis when preoperatively assessing patient's risk for worse outcomes …”