Keywords:
Oncology, Head and neck, CT, Radiation therapy / Oncology, Blood, Inflammation, Outcomes
Authors:
S. P. Ng1, H. Bahig2, C. Pollard III3, E. Sturgis3, F. Johnson3, B. Elgohari3, J. Reddy3, G. B. Gunn3, J. Phan3, D. Rosenthal3, W. Morrison3, S. Frank3, C. Fuller3, A. Garden3; 1VIC/AU, 2Quebec/CA, 3Texas/US
DOI:
10.26044/ranzcr2019/R-0025
Results
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 <0.0001) (Figure 2), and the OS difference was significant when stratified according to HPV status (HPV positive – 5-year OS 85% vs 78%, p=0.011; HPV negative – 5-year OS 88% vs 61%, p=0.003) (Figure 3). Freedom from recurrence (FFR), freedom from locoregional failure (FLF), and freedom of distant recurrence (FDR) were better in those with NLR < 3 (5-year FFR 86% vs 77%, p=0.0009; 5-year FLF 92% vs 85%, p=0.003; 5-year FDR 91% vs 86%, p=0.038) (Figure 2). When stratified according to HPV status, those with NLR < 3 had better 5-year FFR than those with higher NLR (HPV positive - 86% vs 80%, p=0.04; HPV negative - 84% vs 69%, p=0.051). No significant differences were detected in terms of FLF and FDR when stratified according to HPV status.
The negative impact of elevated pre-RT NLR on OS (RR = 1.5, 95% CI 1.13 – 2.08, p=0.005), FFR (RR = 1.5, 95% 1.07 – 2.13, p=0.018), and FLF (RR = 1.6, 95% CI 1.04 – 2.46, p=0.032) remained significant on multivariate analysis.