Prognostic Role of Neutrophil‐to‐Lymphocyte Ratio in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer

Abstract

Objective To investigate the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) for human papillomavirus-positive oropharyngeal cancer (HPV+ OPC). Study Design Retrospective institutional database analysis. Setting Tertiary referral medical center. Material and Methods In total, 104 patients with HPV+ OPC were enrolled. From the blood laboratory data checked within 4 weeks before initiation of primary treatment, NLR was calculated. The association between clinicopathological characteristics and NLR was analyzed, and the prognostic role was evaluated based on overall survival (OS) and disease-free survival (DFS). Results According to the cutoff value (2.42) for NLR, the patients were classified into the low NLR group (n = 61) or the high NLR group (n = 43). High NLR was associated with a higher rate of advanced T classification ( P = .007) and diabetes mellitus ( P = .01). The proportion of surgery-based treatment was lower in the high NLR group (20.9% vs 42.6%, P = .02). The high NLR group showed a lower 5-year OS rate (85.3% vs 96.3%, P = .09) and a lower 5-year DFS rate (68.1% vs 94.7%, P = .01) than those in the low NLR group. Multivariate analysis showed that advanced N classification was a significant predictor for worse 5-year OS (hazard ratio [HR], 17.40; 95% confidence interval [CI], 2.36-128.29) and that both advanced N classification (HR, 7.78; 95% CI, 2.33-25.93) and high NLR (HR, 4.16; 95% CI, 1.24-13.95) were important prognosticators for worse 5-year DFS. Conclusion Elevated pretreatment NLR was associated with poor DFS in patients with HPV+ OPC.

Prognostic significance of neutrophil‐to‐lymphocyte ratio in HPV status era for oropharyngeal cancer

“…This cut-off has also been employed in prospective studies, confirming a prognostic role for this biomarker in head and neck malignancies (Kim et al, 2017;Moon et al, 2016;Zeng et al, 2016). However, those studies considered patients with different primary sites of head and neck districts, and only few reports have been published on OPC only (Huang et al, 2015;Jensen et al, 2017;So et al, 2018). In our study, NLR was associated only with worse OS independently of all known prognostic factors, confirming the literature findings mentioned above.…”

“…In one from So et al, a NLR > 2.42 predicted worse disease-free survival (So et al, 2018). In another one from Gorphe et al, in patients with p16-positive OPC, a NLR > 5 was correlated with worse OS and resulted to be an independent prognostic factor together with Hb level (Gorphe et al, 2018).…”

Prognostic significance of pre-treatment neutrophil-to-lymphocyte ratio (NLR) in patients with oropharyngeal cancer treated with radiotherapy

“… 7 , 9 – 15 The majority of studies have included a heterogeneous group of patients with tumours from differing head and neck subsites. 7 , 11 , 13 – 16 More recently, in a smaller study than ours, So et al 12 reported on a cohort of 104 patients with HPV-associated oropharyngeal cancer and showed that patients with high NLR had worse 5-year disease-free survival. In patients with HPV-negative disease, Lin et al 17 reported that an elevated NLR at 3 months after completion of radiotherapy was associated with worse survival.…”

Neutrophil‐to‐lymphocyte ratio as a prognostic indicator for overall and cancer‐specific survival in squamous cell carcinoma of the head and neck

“…The absence of these biomarkers is a limitation as it has been well documented that HPV or p16 positive oropharyngeal cancers typically have a better prognosis, a unique molecular signature, and a potentially distinct influence on the immune system given its virally mediated process. However, it should be noted that previous studies have examined the role of elevated NLR in HPV+ oropharyngeal squamous cell carcinoma and found an association between poor overall and cancer‐specific survival outcomes and increased NLR 5,36 . In this study, we controlled for upper airway inflammation using smoking and alcohol use as surrogate markers, however we were not able to account for other contributors to inflammation such as oral hygiene given the limited availability of that data.…”