The Potential Prognostic Value of a Novel Hematologic Marker Fibrinogen-to-Lymphocyte Ratio in Head and Neck Adenoid-Cystic Carcinoma

Abstract

Many patients with adenoid-cystic carcinoma (ACC) experience an indolent course of disease over many years but face late recurrence, and long-term survivors are rare. Due to its infrequent occurrence, it is hard to predict outcome in these patients. The fibrinogen-to-lymphocyte ratio (FLR) was recently proposed as an outcome prognosticator in different cancer entities. We aimed to investigate its prognostic relevance in patients with head and neck ACC. This retrospective analysis was performed including all patients treated for ACC between 1998 and 2020. The FLR ratio was calculated based on pretreatment values (0–7 days). The study cohort was dichotomized based on optimized threshold value and compared for differences in outcome (overall survival (OS) and disease-free survival (DFS)). In the cohort of 39 included patients, the OS was significantly longer in the low (n = 28) compared to the high pretreatment FLR group (n = 11) (median OS 150.5 months, 95% confidence intervals (CI) 85.3–215.7 months vs. 29.4 months, 95% CI not reached; p = 0.0093). Similarly, the DFS was significantly longer in the low FLR group (median DFS 74.5 months, 95% CI 30.6–118.4 months vs. 11.0 months, 95% CI 5.1–16.9 months; p = 0.019). The FLR is an easily obtainable and simple marker and may be a valuable outcome prognosticator in patients with ACC. Further studies are needed for validation of our results.

Fibrinogen-to-Lymphocyte Ratio Was an Independent Predictor of Lymph Node Metastasis in Patients with Clinically Node-Negative Advanced-Stage Gastric Cancer

“…21 FLR, combined with hemagglutination and inflammation markers, have a potential prognostic value in different types of cancers, such as non-small cell lung cancer, esophageal cancer, liver cancer, and head and neck adenoid cystic carcinoma. [16][17][18][19] In addition, Huang et al found that a high FLR level was a risk factor for peritoneal metastasis in GC. 20 The current study first reported the association between FLR and LNM in patients with AGC.…”

“…Moreover, it could be a predictor of peritoneal metastasis in GC. [16][17][18][19][20] However, there are no relevant reports focusing on the association between FLR and LNM in patients with GC. Therefore, the current study aimed to assess the predictive value of FLR in LNM in patients with clinically node-negative (cN0) AGC.…”

Development and validation of a nomogram based on neutrophil-to-lymphocyte ratio and fibrinogen-to-lymphocyte ratio for predicting recurrence of colorectal adenoma

“…Moreover, it may reflect the interaction between inflammation and clotting in cancer ( 16 ). FLR has been shown to assess tumor prognosis in carcinoma of stomach ( 15 ), esophagus cancer ( 16 ), non-small cell lung cancer ( 17 ) and head and neck adenoid-cystic carcinoma ( 18 ). In particular, higher FLR values were associated with poorer outcomes.…”

“…Lymphocytes are important antineoplastic factors, which play a significant role in cancer-specific immune response ( 14 ). Recently, a novel prognosticator fibrinogen-to-lymphocyte ratio (FLR) has been proposed, which has been proved to evaluate the prognosis in gastric cancer ( 15 ), esophageal cancer ( 16 ), non-small cell lung cancer ( 17 ) and head and neck adenoid-cystic carcinoma ( 18 ). However, there is no study on the predictive performance of NLR and FLR in CRA recurrence.…”

Lymphocyte-to-Monocyte Ratio Might Serve as a Prognostic Marker in Young Patients with Tongue Squamous Cell Carcinoma

“…Cancer deregulates the immune cells within the tumor microenvironment and systemically, with first deregulations being observed one year prior to diagnosis [24]. To quantify and correlate such deregulations of the immune system with the prognosis and survival of cancer patients, several immune-related markers based on blood cell counts have been described, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) [25][26][27][28]. The predictive value of LMR has been reported in different malignancies [29][30][31][32][33][34][35][36][37][38].…”