The Role of Pretreatment Serum Neutrophil-to-Lymphocyte Ratio in Hypopharyngeal Cancer Treated with Definitive Chemoradiotherapy: A Pilot Study

Abstract

Serum neutrophil-to-lymphocytes ratio (NLR) is a potential predictive and prognostic marker in head and neck cancers. This study aimed to determine the role of pretreatment serum NLR in patients with hypopharyngeal cancer (HPC) treated with definitive chemoradiotherapy. We retrospectively investigated the correlation between clinicopathological parameters and NLR status and analysed its impact on therapeutic response and survival. A total of 120 patients treated at a single institution between 2009 and 2015 were included. The median follow-up time was 24.1 months. High NLR (NLR ≥ 4) was associated with advanced T classification (p = 0.01*) and advanced stage (p = 0.02*) based on chi-square test. We also found that high pretreatment NLR was correlated with poor treatment response (HR = 2.42, 95% CI: 1.08–5.44, p = 0.03*). Pretreatment NLR was also an independent prognostic factor for progression-free survival (HR = 1.71, 95% CI: 1.01–2.90, p = 0.046*) and overall survival (HR = 1.99, 95% CI: 1.21–3.28, p = 0.01*) while correcting for known prognostic factors. Overall, these findings support that NLR is a potential biomarker for host response to tumour aggressiveness, therapeutic response to chemoradiotherapy and survival in HPC patients. This study is limited by its retrospective nature and further validation is warranted.

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

“… 8 In head and neck cancer, NLR has been extensively investigated as a prognostic marker although variable cut-off values and timepoints were used. 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.…”

“… 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 (NLR) is a simple biomarker of systemic inflammation and has been demonstrated to be a prognostic marker in several solid cancers, including prostate, 3 renal, 4 gastric, 5 brain 6 and hypopharyngeal 7 cancers. Here we evaluated the effect of pre-treatment NLR on outcomes in patients with oropharyngeal cancer in the contemporary era.…”

Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer

“…The findings of increased NLR with increased T and N category disease in the general realm of head and neck cancer has been reported as well. 22 , 28 - 30 …”

“…The findings of increased NLR with increased T and N category disease in the general realm of head and neck cancer has been reported as well. 22,[28][29][30] Our study retains the inherent limitations of a retrospective database analysis. There is potential for selection bias within our design as not all patients had available lab parameters available (Figure 1), but we have little reason to believe this would disproportionately affect either cohort.…”