title: Neutrophil-to-lymphocyte ratio in head and neck cancer.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Haddad
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Linxin
authors.initials: L
authors.lastname: Guo
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.|Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Clarke
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.|Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Guminski
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.|Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Back
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.|Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Eade
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D015415:Biomarkers
keywords: NLR; head and neck cancer; inflammation; neutrophil-to-lymphocyte ratio; radiotherapy