A high neutrophil-lymphocyte ratio (NLR) is associated with worse survival in some patients with head and neck cancer, according to study results published in JAMA Network Open.
An NLR of 5.71 or higher was associated with worse overall survival (OS) and cancer-specific survival (CSS) in the overall cohort.
However, a high NLR was not associated with OS or CSS when researchers looked only at patients with HPV-associated head and neck cancers.
The retrospective study included 496 patients with nonmetastatic head and neck cancer. Most patients were men (82.9%), White (87.1%), had been diagnosed with oropharyngeal cancer (55.6%), and underwent definitive chemoradiation with cisplatin (84.5%). The median age of the patients was 61 (range, 55 to 67) years. They had a median NLR of 2.8, and the median follow-up was 44.4 months.
The researchers found that an NLR of 5.71 or higher was associated with significantly worse OS (adjusted hazard ratio [aHR], 1.97; 95% CI, 1.26-3.09; P =.003) and CSS (aHR, 2.33; 95% CI, 1.38-3.95; P =.002). The 3-year OS was 77.3% in the low NLR cohort and 43.0% in the high NLR cohort. The 3-year CSS was 83.4% and 55.6%, respectively.
On multivariate analysis, patients were more likely to have a high NLR if they had a higher T stage (T3-4: adjusted odds ratio [aOR], 4.07; P <.001) or N stage (N2: aOR, 2.97; P =.049; N3: aOR, 11.21; P <.001). Patients were less likely to have a high NLR if they had a good Karnofsky Performance Status (90-100; aOR, 0.29; P <.001).
Of the 331 patients with available HPV data, 239 had HPV-associated head and neck cancers. In these patients, a high NLR was not associated with OS regardless of HPV status (HPV-negative: aHR, 2.46; P =.06; HPV-positive: aHR, 1.17; P =.78). Likewise, a high NLR was not associated with CSS (HPV-negative: aHR, 2.55; P =.11; HPV-positive: aHR, 1.45; P =.54).
“These findings suggest that high neutrophil-lymphocyte ratio could be an independent, adverse prognostic factor, and further studies would be warranted to tailor treatments among high-risk patients,” the researchers concluded.
Ma SJ, Yu H, Khan M, et al. Evaluation of optimal threshold of neutrophil-lymphocyte ratio and its association with survival outcomes among patients with head and neck cancer. JAMA Netw Open. 2022;5(4):e227567. doi:10.1001/jamanetworkopen.2022.7567