Neutrophil-to-lymphocyte ratio in head and neck cancer.
INTRODUCTION
The neutrophil-to-lymphocyte ratio (NLR) is an index of systemic inflammatory burden in malignancy. An elevated NLR has been associated with poor prognosis in a number of cancer sites. We investigated its role in a cohort of patients with locally advanced head and neck cancer.


METHODS
Eligible patients had primary mucosal squamous cell carcinoma treated with chemoradiotherapy and a minimum follow-up of 12 months (unless deceased). NLR was analysed as <5 vs. ≥5 and above and below the median. The primary endpoint was overall survival (OS) and secondary endpoints metastasis free survival and locoregional relapse free survival. Actuarial Kaplan-Meier statistics and log rank test were used. Univariate analysis for age (continuous), Eastern Cooperative Oncology Group performance status (0 vs. 1), gender (male vs. female), smoking (yes vs. no), American Joint Committee on Cancer stage (III vs. IV) and NLR (<5 vs. ≥5 and <3.3 vs. ≥3.3) were performed.


RESULTS
Forty-six patients were included in this analysis. Median NLR was 3.3 (0.4-22.8). After a median follow-up of 34 months (13-47 months), the 2-year estimated OS, metastasis free survival and locoregional relapse free survival for NLR <5 vs. ≥5 were 89% vs. 61% (p = 0.017), 84% vs. 64% (p = 0.083) and 81% vs. 70% (p = 0.17) respectively. On univariate analysis NLR ≥5 (p = 0.025), older age (p = 0.01) and ECOG 1 (p = 0.025) were significant for OS.


CONCLUSION
In this cohort of locally advanced head and neck cancer patients treated with chemoradiotherapy, pre-treatment NLR ≥5 was prognostic for mortality. Further studies are required to confirm these results and to assess the interaction with other prognostic factors.
['Haddad|Carol R|CR|', 'Guo|Linxin|L|', 'Clarke|Stephen|S|', 'Guminski|Alex|A|', 'Back|Michael|M|', 'Eade|Thomas|T|']
D000368:Aged D000369:Aged, 80 and over D015415:Biomarkers D002294:Carcinoma, Squamous Cell D018572:Disease-Free Survival D005260:Female D006258:Head and Neck Neoplasms D006801:Humans D007958:Leukocyte Count D008214:Lymphocytes D008297:Male D008875:Middle Aged D009504:Neutrophils D009517:New South Wales D015995:Prevalence D015203:Reproducibility of Results D012307:Risk Factors D012680:Sensitivity and Specificity D015996:Survival Rate
neutrophil-to-lymphocyte ratio head and neck cancer NLR inflammation radiotherapy