Neutrophil-Lymphocyte Ratio Prognosticates Survival in Head and Neck Cancer

Study findings suggest having a high neutrophil-lymphocyte ratio was associated with worse overall survival (OS) and cancer-specific survival in patients with nonmetastatic head and neck cancer.

“[Given the role of inflammation in cancer progression, neutrophil-lymphocyte ratio from peripheral blood has been suggested as a readout of systemic inflammation and a prognostic marker in several solid malignant neoplasms. However, optimal threshold for [neutrophil-lymphocyte ratio] in US patients with head and neck cancer remains unclear,” wrote lead author Sung Ma, MD, Roswell Park Comprehensive Cancer Center, department of radiation medicine, Buffalo, New York, and coauthors.

This study aimed to determine the optimal neutrophil-lymphocyte ratio threshold as a potential prognostic biomarker for survival outcomes among these patients.

Dr Ma and collegaues analyzed data from 496 patients at Roswell Park Comprehensive Cancer Center who underwent chemoradiation between April 2007 and March 2021. Over half (55.6%) had oropharyngeal cancer. Nearly 80% were either former or current smokers.

All participants were treated with curative-intent definitive chemoradiation, receiving 70 Gy to gross disease and 56 Gy to elective neck lymph nodes. Most (84.5%) were treated with cisplatin. Of the cohort, 82.9% self-reported as male and 87.1% were White, with a median age of 61. The median follow-up was 44.4 months, and the statistical analysis was performed from September to December 2021.

The threshold of neutrophil-lymphocyte ratio for both OS and cancer-specific survival were 5.71. A neutrophil-lymphocyte ratio above 5.71 was associated with worse OS (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.26 to 3.09; P = .003) and CSS (aHR, 2.33; 95% CI, 1.38 to 3.95; P = .002).

Patients were more likely to have high neutrophil-lymphocyte ratio if they had higher T staging (T3-4 odds ratio [OR], 4.07; 95% CI, 1.92 to 9.16; P <.001) and N staging (N2 OR, 2.97; P = .049; N3: OR, 11.21; P <.001), but less likely if they had a good performance status (Karnofsky Performance Status 90-100: OR, 0.29; 95% CI, 0.14 to 0.59; P <.001). Receiving any chemotherapy other than cisplatin was associated with high neutrophil-lymphocyte ratio (OR 4.24; P = .001).

Source:

Ma S, Yu H, Khan M, et al. Evaluation of Optimal Threshold of Neutrophil-Lymphocyte Ratio and Its Association With Survival Outcomes Among Patients With Head and Neck Cancer. JAMA Netw Open. 2022 Apr 1;5(4):e227567. doi:10.1001/jamanetworkopen.2022.7567.