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

• Published in: British journal of cancer Vol. 124; no. 3; pp. 628 - 633
• Main Authors: Ng, Sweet Ping, Bahig, Houda, Jethanandani, Amit, Sturgis, Erich M., Johnson, Faye M., Elgohari, Baher, Gunn, G. Brandon, Ferrarotto, Renata, Phan, Jack, Rosenthal, David I., Frank, Steven J., Fuller, Clifton D., Garden, Adam S.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 02.02.2021; Nature Publishing Group
• Subjects: 692/4028/67/1536; 692/53/2422; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Carcinoma, Squamous Cell - blood; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - virology; Disease control; Drug Resistance; Epidemiology; Female; Human papillomavirus; Humans; Kaplan-Meier Estimate; Leukocyte Count; Leukocytes (neutrophilic); Lymphocyte Count; Lymphocytes; Male; Medical prognosis; Middle Aged; Molecular Medicine; Neutrophils; Oncology; Oropharyngeal cancer; Oropharyngeal Neoplasms - blood; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - radiotherapy; Oropharyngeal Neoplasms - virology; Papillomaviridae - isolation & purification; Prognosis; Radiation therapy; Regression Analysis; Retrospective Studies; Throat cancer; Time Factors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-020-01106-x

Background This study aimed to evaluate the prognostic value of pre-treatment NLR in patients with oropharyngeal cancer. Methods Patients who completed definitive radiotherapy (RT) for oropharyngeal cancer and had blood counts taken pre-RT from 2002 to 2013 were included. NLR was calculated as total neutrophil/lymphocytes. Survival rates were estimated using the Kaplan–Meier method. Univariable and multivariable analyses were conducted with linear and Cox regression methods. NLR was analysed posteriori and dichotomised on the discovered median. Results Eight hundred and forty-eight patients were analysed. The median pre-RT NLR was 3. Patients with NLR of <3 had improved overall survival (OS) than those with NLR ≥ 3 (5-year OS 85 vs 74%, p  < 0.0001). OS differences remained significant when stratified according to HPV status (HPV-positive p  = 0.011; HPV-negative p  = 0.003). Freedom from any recurrence (FFR), locoregional control (LRC) and freedom of distant recurrence (FDR) were better in those with NLR < 3. The negative impact of elevated pre-RT NLR on OS (HR = 1.64, p  = 0.001), FFR (HR = 1.6, p  = 0.006) and LRC (HR = 1.8, p  = 0.005) remained significant on multivariable analysis. Conclusions Pre-RT NLR is an independent prognostic factor in patients with oropharyngeal cancer regardless of HPV status. Patients with lower NLR had more favourable OS and disease control.