title: Systemic inflammation is an independent predictive marker of clinical outcomes in mucosal squamous cell carcinoma of the head and neck in oropharyngeal and non-oropharyngeal patients.
abstract: BACKGROUND
  Currently there are very few biomarkers to identify head and neck squamous cell carcinoma (HNSCC) cancer patients at a greater risk of recurrence and shortened survival. This study aimed to investigate whether a marker of systemic inflammation, the neutrophil-to-lymphocyte ratio (NLR), was predictive of clinical outcomes in a heterogeneous cohort of HNSCC cancer patients.
  
  
  METHODS
  We performed a retrospective analysis to identify associations between NLR and clinicopathological features to recurrence free survival (RFS) and overall survival (OS). Univariate analysis was used to identify associations and selected variables were included in multivariable Cox regression analysis to determine predictive value.
  
  
  RESULTS
  A total of 145 patients with stage I-IV HNSCC that had undergone radiotherapy were analysed. Seventy-six of these patients had oropharyngeal cancer and 69 had non-oropharyngeal HNSCC and these populations were analysed separately. NLR was not associated to any clinicopathological variable. On univariate analysis, NLR showed associations with RFS and OS in both sub-populations. Multivariable analysis showed patients with NLR > 5 had shortened OS in both sub-populations but NLR > 5 only predicted RFS in oropharyngeal patients. Poor performance status predicted OS in both sub-populations and current smokers had shortened OS and RFS in non-oropharyngeal patients.
  
  
  CONCLUSIONS
  The results show patients with NLR > 5 predict for shorter overall survival. Further prospective validation studies in larger cohorts are required to determine the clinical applicability of NLR for prognostication in HNSCC patients.
authors.affiliation: School of Medical Sciences (Pharmacology) and Bosch Institute, University of Sydney, Sydney, NSW, 2006, Australia. kellie.charles@sydney.edu.au.
authors.forename: Kellie A
authors.initials: KA
authors.lastname: Charles
authors.affiliation: School of Medical Sciences (Pharmacology) and Bosch Institute, University of Sydney, Sydney, NSW, 2006, Australia. b.harris@sydney.edu.au.
authors.forename: Benjamin D W
authors.initials: BD
authors.lastname: Harris
authors.affiliation: Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. chad2089@med.usyd.edu.au.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Haddad
authors.affiliation: Northern Clinical School (Medicine), University of Sydney, Sydney, NSW, 2006, Australia. stephen.clarke@sydney.edu.au.|Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. stephen.clarke@sydney.edu.au.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Clarke
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. alexander.guminski@health.nsw.gov.au.
authors.forename: Alex
authors.initials: A
authors.lastname: Guminski
authors.affiliation: Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. mjstevens@ausdoctors.net.|Northern Clinical School (Medicine), University of Sydney, Sydney, NSW, 2006, Australia. mjstevens@ausdoctors.net.
authors.forename: Mark
authors.initials: M
authors.lastname: Stevens
authors.affiliation: Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. tristandodds@gmail.com.|Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, 2006, Australia. tristandodds@gmail.com.
authors.forename: Tristan
authors.initials: T
authors.lastname: Dodds
authors.affiliation: Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. a.gill@sydney.edu.au.|Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, 2006, Australia. a.gill@sydney.edu.au.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.affiliation: Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. michael.back@sydney.edu.au.|Northern Clinical School (Medicine), University of Sydney, Sydney, NSW, 2006, Australia. michael.back@sydney.edu.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Back
authors.affiliation: Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. drveivers@nshank.com.au.
authors.forename: David
authors.initials: D
authors.lastname: Veivers
authors.affiliation: Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. Thomas.Eade@health.nsw.gov.au.|Northern Clinical School (Medicine), University of Sydney, Sydney, NSW, 2006, Australia. Thomas.Eade@health.nsw.gov.au.
authors.forename: Thomas
authors.initials: T
authors.lastname: Eade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000276:immunology*; D002294:Carcinoma, Squamous Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor