title: Refining the role of preoperative C-reactive protein by neutrophil/lymphocyte ratio in oral cavity squamous cell carcinoma.
abstract: OBJECTIVE
  Elevated inflammatory biomarkers such as C-reactive protein (CRP) and the recently identified neutrophil/lymphocyte ratio (NLR) were demonstrated to be associated with prognosis in human cancers. The aim of our present study is to analyze the relationship of preoperative levels of CRP and NLR with clinicopathological factors and prognosis in oral squamous cell carcinoma (OSCC) patients.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  This study was performed on 226 OSCC patients between July 2007 and April 2012. Their serum CRP levels and NLR were measured preoperatively.
  
  
  RESULTS
  CRP level ≥ 5.0 mg/L was significantly associated with NLR ≥ 2.44 (linear regression, P < .001). Elevated CRP and NLR were significantly associated with pathological tumor status (P < .001), pathologic nodal metastasis (P < .001), tumor depth (≥10 mm vs. <10 mm, P < .001), disease-free survival (P < .001), and overall survival (P = .001). The influence of CRP level and NLR on disease-free survival (hazard ratio [HR] = 2.259, 95% confidence interval [CI] = 1.170-4.361) and overall survival (HR = 2.176, 95% CI = 1.116-4.245]) still existed after adjusting for tumor status, lymph node metastasis, and tumor cell differentiation.
  
  
  CONCLUSIONS
  The present study demonstrates that elevated CRP is an independent prognostic factor in OSCC. Elevated NLR in the high CRP group identifies patients at high risks of recurrence and shorter survival. Incorporating NLR into CRP level therefore has significant potential as a biomarker for risk stratification in OSCC.
authors.affiliation: Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China.
authors.forename: Hsuan-Yeh
authors.initials: HY
authors.lastname: Fang
authors.forename: Xin Yong
authors.initials: XY
authors.lastname: Huang
authors.forename: Huei-Tzu
authors.initials: HT
authors.lastname: Chien
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Huang
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D002294:Carcinoma, Squamous Cell / Q000097:blood*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000097:blood*; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Oral cavity squamous cell carcinoma; neutrophil/lymphocyte ratio; prognosticator