title: Preoperative Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Oral Squamous Cell Carcinoma: A Large-Sample Prospective Study.
abstract: OBJECTIVE
  To assess and determine the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with oral squamous cell carcinoma (OSCC).
  
  
  METHODS
  The prospective study involving 1,202 patients with OSCC and surgical resection was carried out in Fujian, China. Two-stage analyses were performed by randomly dividing all patients into 800 discovery and 402 replication sets. The optimal NLR cutoff points were identified by the X-tile program with minimum P values. Prognostic factors were evaluated using univariate and multivariate Cox regression models.
  
  
  RESULTS
  The discovery set was categorized as low-, middle-, and high-risk groups based on optimal NLR cutoff points (<1.94, 1.94 to 3.66, and >3.66, respectively). A high NLR was meaningfully associated with an increased risk of death on survival (NLR 1.94 to 3.66, hazard ratio [HR] = 1.51; 95% confidence interval [CI], 1.09-2.08; NLR >3.66, HR = 1.76; 95% CI, 1.21-2.55). In the replication phase, patients with a high NLR showed considerably worse overall survival compared with those with a low NLR (NLR 1.94 to 3.66, HR = 1.61; 95% CI, 1.02-2.55; NLR >3.66, HR = 1.94; 95% CI, 1.16-3.27). In addition, better overall survival was observed for patients with a higher NLR who had received postoperative chemoradiotherapy (HR = 0.49; 95% CI, 0.26-0.92).
  
  
  CONCLUSIONS
  The preoperative NLR is an independent factor in predicting the prognosis of OSCC, especially for patients with chemoradiotherapy, which could serve as a potential target for improving patients' prognosis.
authors.affiliation: Doctoral Candidate, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Fa
authors.initials: F
authors.lastname: Chen
authors.affiliation: Physician, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Lisong
authors.initials: L
authors.lastname: Lin
authors.affiliation: Master Degree Candidate, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Lingjun
authors.initials: L
authors.lastname: Yan
authors.affiliation: Physician, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Professor, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Cai
authors.affiliation: Associate Professor, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China. Electronic address: prof_hbc@163.com.
authors.forename: Baochang
authors.initials: B
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D011897:Random Allocation; D015996:Survival Rate