Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and has been demonstrated to be a prognostic marker in several cancers including hypopharyngeal and prostate cancers1-2. The impact of systemic inflammation in patients with oropharyngeal cancer, particularly those with human papillomavirus (HPV)-related disease remain unknown. Here, we evaluated the effect of pre-treatment NLR on outcomes in patients with oropharyngeal cancer.
Methods and materials
A retrospective analysis of patients who completed definitive radiotherapy (RT) for oropharyngeal cancer at The University of Texas MD Anderson Cancer Center and had pre-treatmentblood counts taken beforeRT from 2002 to 2013 were included. Patient, tumor and treatment characteristics, clinical outcomes, and total neutrophil (TNC) and lymphocyte counts (TLC) pre-radiotherapywere recorded. Neutrophil-to-lymphocyte ratio (NLR) prior to radiotherapy and was calculated as TNC/ TLC. Survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. Univariate and multivariate analyses were conducted with linear and...
849 patients were eligible for analysis (Figure 1). The median age was 57 years and 87% were males. The primary sites were mainly base of tongue (55%) and tonsil (43%). Six hundred three (71%) had p16/ HPV-positive disease and 43% were never smokers. Seven hundred forty-seven (88%) received concurrent chemotherapy. The median pre-treatment NLR was 3.
Patients who had NLR of< 3 had significantly improved overall survival (OS) than those with NLR≥ 3 (5-year OS 85% vs 74%, p
Pre-treatment NLR is an independent prognostic factor in patients with oropharyngeal cancer regardless of HPV status. Patients with lower NLR had more favorable OS and disease control. Further studies evaluating the incorporation of systemic inflammation indicators to further stratify patients for treatment personalisation is required.
Dr. Sweet Ping Ng is a radiation oncologist at the Peter MacCallum Cancer Centre. She recently completed her fellowship at the University of Texas MD Anderson Cancer Center. She is also completing her PhD studies in imaging and blood biomarkers in head and neck cancer in a joint study between MD Anderson Cancer Centre and Peter MacCallum Cancer Centre.
1.Kuo C, Hsueh WT, Wu YH, et al: The Role of Pretreatment Serum Neutrophil-to-Lymphocyte Ratio in Hypopharyngeal Cancer Treated with Definitive Chemoradiotherapy: A Pilot Study. Sci Rep 9:1618, 2019
2.Conteduca V, Crabb SJ, Jones RJ, et al: Persistent Neutrophil to Lymphocyte Ratio >3 during Treatment with Enzalutamide and Clinical Outcome in Patients with Castration-Resistant Prostate Cancer. PLoS One 11:e0158952, 2016