Background

To evaluate the prognostic value of Neutrophil to Lymphocyte Ratio (NLR) in oropharyngeal squamous cell carcinoma (SCC) treated with radical chemo-radiotherapy.

Method

249 patients with oropharyngeal SCC, treated between 2004-2010, with chemo-radiotherapy +/- induction chemotherapy (ICT), were retrospectively identified. Full blood count prior to treatment was used to calculate NLR. Univariate analysis and then Cox regression (backward likelihood ratio) were performed to identify prognostic factors. Age, gender, T stage, N stage, grade, smoking status, use of ICT, number of concurrent chemotherapy cycles, NLR, haemoglobin and platelet to lymphocyte ratio were included in the Cox model.

Results

Median age was 55 (range 31-78). Median follow-up was 46 months (range 9- 98). 154 patients (62%) received ICT. Three year local, regional, distant control and overall survival were 85%, 87%, 87% and 70% respectively.

Multi-variate Cox regression demonstrated:

For local control, T stage and NLR were significant:

• T stage (3/4 vs 1/2): Hazard ratio (HR) 3.96 (95% confidence interval (CI):1.61-9.74, p=0.003)
• NLR (≥5 vs <5): HR 2.52 (95% CI 1.26-5.02, p=0.009).

For regional control, only NLR was significant:

• NLR (≥5 vs <5): HR 2.76 (95% CI: 1.29-5.93, p=0.009).

For distant control, only T stage was significant:

T stage (3/4 vs 1/2): HR 2.96 (95% CI: 1.18-7.42, p=0.021)

For overall survival, grade and T stage were significant:

• Grade (3 vs 1/2): HR 0.61 (95% CI: 0.38-0.99, p=0.048)
• T stage (3/4 vs 1/2): HR 2.47 (95% CI: 1.45-4.21, p=0.001).

Conclusion

NLR is an independent prognostic variable for local and regional control for oropharyngeal SCC treated with chemo-radiotherapy. Knowledge of NLR could potentially be used to risk stratify patients with regard to loco-regional treatment strategy.