Impact of Pretreatment Inflammatory Markers in Locally Advanced Head and Neck Cancer Treated with Concurrent Chemoradiotherapy

• Published in: Middle East journal of cancer Vol. 15; no. 3; pp. 226 - 233
• Main Authors: Deep Shankar Pruthi, Puneet Nagpal, Manish Pandey, Ashu Yadav
• Format: Journal Article
• Language: English
• Published: Shiraz University of Medical Sciences 01.07.2024
• Subjects: head and neck neoplasms; inflammatory markers; neutrophil-lymphocyte ratio; prognosis; radiotherapy
• ISSN: 2008-6709; 2008-6687
• DOI: 10.30476/mejc.2023.99132.1929

Background: Inflammation, when associated with cancer, has been shown to correlate with a worse prognosis. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) serve as markers of inflammation. This study aims to investigate the influence of pretreatment NLR, PLR, and MLR on treatment outcomes and their correlation with sarcopenia in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) undergoing definitive chemoradiotherapy. Method: In this retrospective study, 240 LA-HNSCC patients who received a radiotherapy dose of 70 Gy/35 fractions over 7 weeks in conjunction with chemotherapy were enrolled. Pretreatment NLR, PLR, and MLR were determined. Sarcopenia was evaluated by measuring skeletal muscle mass at the C3 level using radiotherapy planning computed tomography scans. The impact of NLR, PLR, and MLR on complete response rate and disease-free survival was calculated. The median follow-up duration for patients was 26 months. Results: Inflammatory markers were notably higher in elderly patients, females, and those with laryngeal primary tumours. Patients achieving a complete response exhibited lower values than those who did not. Patients with significant sarcopenia demonstrated elevated mean values of inflammatory markers. Patients with NLR<3, PLR<145, and MLR<0.4 experienced more favorable outcomes regarding complete response rate and disease-free survival. Conclusion: Inflammatory markers such as NLR, PLR, and MLR are independent prognostic factors in HNSCC patients. Elevated values are associated with sarcopenia and inferior treatment outcomes, indicative of more aggressive tumour behavior. These markers are straightforward to calculate and should be routinely employed for early prognosis assessment.