title: Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes in oropharyngeal cancer stratified by human papillomavirus status.
abstract: BACKGROUND
  The objective of this study was to investigate the prognostic value of the pretreatment circulating neutrophil count (CNC), circulating monocyte count (CMC), and circulating lymphocyte count (CLC) in human papillomavirus (HPV)-related (HPV+) and HPV-unrelated (HPV-) oropharyngeal cancer (OPC).
  
  
  METHODS
  All p16-confirmed HPV+ and HPV- OPC cases treated with chemoradiotherapy from 2000 to 2010 were included. Overall survival (OS) and recurrence-free survival (RFS) were compared for high and low CNCs, CMCs, and CLCs (dichotomized by median values). A multivariate analysis (MVA) confirmed their prognostic value in HPV+ and HPV- tumors, respectively.
  
  
  RESULTS
  Five hundred ten HPV+ OPC cases and 192 HPV- OPC cases were included. The HPV+ cohort had lower CNC and CMC values but a CLC similar to that of the HPV- patients (P < .01). The median follow-up was 4.8 years. In the HPV+ cohort, a high CNC or CMC correlated with reduced OS and RFS in comparison with a low CNC or CMC (P < .01 for all), but no difference was evident in OS (P = .30) or RFS (P = .10) with the CLC. MVA confirmed that a higher CNC or CMC independently predicted lower OS (hazard ratio [HR] for CNC, 1.14, P < .01; HR for CMC, 2.95, P < .01) and lower RFS (HR for CNC, 1.11, P < .01; HR for CMC, 3.39, P < .01), whereas a higher CLC was associated with higher RFS (HR, 0.66, P = .03) and marginally higher OS (HR, 0.80, P = .08). In the HPV- cohort, CNC, CMC, and CLC were not predictive of OS (P = .16, P = .86, and P = .14) or RFS (P = .61, P = .59, and P = .62).
  
  
  CONCLUSIONS
  This relatively large cohort study demonstrates that a high CNC and a high CMC independently predict inferior OS and RFS, whereas a high CLC predicts better RFS and marginally better OS in HPV+ OPC patients. This association was not apparent in HPV- patients.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: John N
authors.initials: JN
authors.lastname: Waldron
authors.forename: Michael
authors.initials: M
authors.lastname: Milosevic
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Shen
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.forename: Jie
authors.initials: J
authors.lastname: Su
authors.forename: Li
authors.initials: L
authors.lastname: Tong
authors.forename: Bayardo
authors.initials: B
authors.lastname: Perez-Ordonez
authors.forename: Ilan
authors.initials: I
authors.lastname: Weinreb
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bayley
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Andrew
authors.initials: A
authors.lastname: Hope
authors.forename: B C John
authors.initials: BC
authors.lastname: Cho
authors.forename: Meredith
authors.initials: M
authors.lastname: Giuliani
authors.forename: Albiruni
authors.initials: A
authors.lastname: Razak
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Willa
authors.initials: W
authors.lastname: Shi
authors.forename: Fei-Fei
authors.initials: FF
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000821:virology; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009504:Neutrophils; D016017:Odds Ratio; D009959:Oropharyngeal Neoplasms / Q000097:blood* / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D014062:Tongue Neoplasms / Q000097:blood / Q000821:virology; D014067:Tonsillar Neoplasms / Q000097:blood / Q000821:virology
keywords: human papillomavirus (HPV); lymphocytes; monocytes; neutrophils; oropharyngeal cancer; outcomes