Role of systemic inflammatory markers (biomarkers) as important prognostic factors for survival in head and neck cancer
Keywords:NLR, PLR, prognostic factors, head neck cancer (HNC)
Introduction and Aim: Cancer related inflammation is recognized as a critical multifaceted player in tumour initiation and progression. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important markers of systemic inflammatory burden in malignancy. The present retrospective study aimed to evaluate the prognostic value of pre-treatment baseline (NLR) and (PLR) for survival in HNC patients.
Materials and Methods: Analysis of data of 257 patients with head and neck cancer treated with definitive therapy over 3.5 yrs. Neutrophil, lymphocyte and platelet counts before treatment of all patients were collected and NLR and PLR were calculated.
Results: Median value of NLR and PLR were 3.7 and 170.63 respectively. Receiver operator characteristics (ROC) curve analysis showed the predictive cut-off value of NLR and PLR as 3.9 and 158.3. Univariate analysis using Cox-regression model showed NLR (p < 0.001) and PLR (p = 0.001) significantly influenced the locoregional recurrence free survival (LRRFS) and overall survival (OS). The multivariate analysis showed NLR is the independent prognostic factors influencing LRRFS (p = 0.007) and OS (p = 0.002). Kaplan-Meier survival curve (Log rank test; Chi-square (?2) value) showed OS is significantly influenced by NLR group (LRRFS; ?2 = 23.9 and OS; ?2 = 33.7) and PLR group (LRRFS; ?2 = 11.2 and OS; ?2 = 19.3) in contrast to LRRFS.
Conclusion: NLR can be strongly used as biomarker for prognostication for outcome and survival in head neck cancer. However, a well-designed, larger studies with longer follow-up is warranted.
Grégoire, V., Lefebvre, J. L., Licitra, L., Felip, E. EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical practice guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2010; 21(5): 184-186.
GLOBOCAN 2012 (IARC) Section of Cancer Surveillance. [Last accessed on 2016 Jun 23]. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
Hanahan, D., Weinberg, R. A. Hallmarks of cancer: the next generation. Cell. 2011; 144(5): 646-674.
Balkwill, F., Mantovani, A. Inflammation and cancer: back to Virchow? Lancet. 2001; 357: 539–545.
Atzpodien, J., Royston, P., Wandert, T., Reitz, M. Group D.G.C.R.C.C.-I.T. Metastatic renal carcinoma comprehensive prognostic system. Br. J. Cancer. 2003; 88: 348-353. doi: 10.1038/sj.bjc.6600768.
Rosculet, N., Zhou, X.C., Ha, P., Tang, M., Levine, M.A., Neuner, G., Califano J. Neutrophil-to-lymphocyte ratio: Prognostic indicator for head and neck squamous cell carcinoma. Head Neck. 2017; 39: 662-667. doi: 10.1002/hed.24658.
Demers, M., Wagner, D. D. Neutrophil extracellular traps: a new link to cancer-associated thrombosis and potential implications for tumor progression. Oncoimmunology. 2013; 2(2): e2294614.
Buergy, D., Wenz, F., Groden, C., Brockmann, M. A. Tumor-Platelet interaction in solid tumors. Int. J. Cancer. 2012; 130: 2747-2760. doi: 10.1002/ijc.27441.
Ozawa, T., Ishihara, S., Nishikawa, T., Tanaka, T., Tanaka, J., Kiyomatsu, T.et al. The preoperative platelet to lymphocyte ratio is a prognostic marker in patients with stage II colorectal cancer. Int J Colorectal Dis 2015; 30: 1165-1171.
Edge, S. B., Compton, C. C., Fritz, A. G., Green, F. L. AJCC cancer staging manual. Springer, New York. 2012; 7.
Oken, M., Creech, R., Tormey, D., Horton, J., Davis, T., McFadden, E., et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group; https://ecog-acrin.org/resources/ecog-performance-status. (Accessed 3rd January 2015)
Coussens, L. M., Werb, Z. Inflammation and cancer. Nature. 2002; 420(6917): 860.
Bhattacharjee, A., Chakraborty, A., Purkaystha, P. Prevalence of head and neck cancers in the North East-an institutional study. Indian Journal of Otolaryngology and Head and Neck Surgery. 2006; 58(1): 15-19.
Mehanna, H., Paleri, V., West, C., Nutting, C. Head and neck cancer-Part 1: Epidemiology, presentation, and prevention. BMJ. 2010; 341(7774): 663-666.
Alvarenga, L. D. M., Ruiz, M. T., Pavarino-Bertelli, É.C., Ruback M., Maniglia J., Goloni-Bertollo, M. Epidemiologic evaluation of head and neck patients in a university hospital of Northwestern São Paulo State. RevistaBrasileira de Otorrinolaringologia. 2008; 74(1): 68-73.
Andisheh-Tadbir, A., Ashrafi, M., Jafari-Ashkavandi, Z., Paknahad, M., Taheri, F. Head and neck squamous cell carcinoma in Southern Iran. Iran Red Crescent Med J. 2008; 10: 309-313.
Addala, L., Pentapati, C. K., Reddy, K., Thavanati, P. K., Anjaneyulu, V., Sadhnani, M. D. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer 2012; 49: 215-219.
Shenoi, R., Devrukhkar, V., Chaudhuri, K., Sharma, B. K., Sapre, S. B., Chikhale, A., et al., Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Indian J Cancer. 2012; 49: 21-26.
Malik, A., Mishra, A., Mair, M., Chakrabarti, S. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic markers in oral cavity cancers. Indian Journal of Medical and Pedriatic Oncology. 2019; 40(1): 94-100.
Cho, Y., Kim, J. W., Yoon, H. I. The prognostic significance of neutrophil-to-lymphocyte ratio in head and neck cancer patients treated with radiotherapy. J Clin Med.2018; 7(12): 512.
Bojaxhiu, B., Arnoud, J., Templeton, M., Elicin, O., Shelan, M. Relation of baseline neutrophil-to-lymphocyte ratio to survival and toxicity in head and neck cancer patients treated with (chemo-) radiation. Radiation Oncology. 2018; 13: Article number: 216.
Szilasi, Z., Jósa, V., Zrubka, Z., Mezei, T., Vass, T., Merkel, K. et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as prognostic markers of survival in patients with head and neck tumours—results of a retrospective multicentric study. Int J Enviorn Res Public Health. 2020; 17(5): 1742.
Tazeen, S., Prasad, K., Harrish, K., Sagar, P., Kapali, A. S., Chandramouli, S. Assessment of Pre-treatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Prognosis of Oral Squamous Cell Carcinom. Journal of Oral and Maxillofacial Surgery. 2020; 78(6): 949-60
Sano, Y., Kogashiwa, Y., Araki, R., Enok, Y., Ikeda, T., Yoda, T. et al. Correlation of inflammatory markers, survival, and COX2 expression in oral cancer and implications for prognosis. Otolaryngology– Head and Neck Surgery. 2018; 158(4): 667-676.
Espeli, V. G., Martucci, F., Richetti, A., Pastore, A. Prognostic neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in locally advanced oropharyngeal cancer: a retrospective experience of two institutions. JCO. 2019; 37 (15) Suppl.
Mantovani, A., Schioppa, T., Porta, C., Allavena, P., Sica, A. Role of tumor-associated macrophages in tumor progression and invasion. Cancer Metastasis Rev. 2006; 25: 315-322. doi: 10.1007/s10555-006-9001-7.
Sierko, E., Wojtukiewicz, M. Z. Inhibition of platelet function: Does it offer a chance of better cancer progression control? Semin. Thrombosis Hemost. 2007; 33: 712–721. doi: 10.1055/s-2007-991540.
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