Neutrophil to Lymphocyte Ratio in Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

• Type of Material: Article
• Authors: Juan P Rodrigo, University of Oviedo; Mario Sanchez-Canteli, University of Oviedo; Asterios Triantafyllou, University of Liverpool; Remco de Bree, Utrecht University; Antti A Mäkitie, University of Helsinki; Alessandro Franchi, University of Pisa; Henrik Hellquist, Univ Algarve; Nabil Saba, Emory University; Göran Stenman, University of Gothenburg; Robert P Takes, Radboud University Medical Center; Cristina Valero, Universitat Autònoma de Barcelona; Nina Zidar, University of Ljubljana; Alfio Ferlito, Head and Neck Scientific Group
• Language: English
• Date: 2023-02-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/cancers15030802
• Title of Journal or Parent Work: CANCERS
• Volume: 15
• Issue: 3
• Grant/Funding Information: This study was supported by grants from the Plan Nacional de I+D+I 2013–2016 (ISCIII (PI19/00560 to J.P.R.), CIBERONC (CB16/12/00390 to J.P.R.), Ayudas a Grupos PCTI Principado de Asturias (IDI/2021/000079 to J.P.R.), and the FEDER Funding Program from the European Union.
• Keywords: INDEPENDENT PROGNOSTIC-FACTOR; meta-analysis; MONOCYTES; HUMAN-PAPILLOMAVIRUS; COUNT; Life Sciences & Biomedicine; prognosis; HEAD; Oncology; Science & Technology; NECK-CANCER; MARKERS; neutrophil-to-lymphocyte ratio; oropharyngeal squamous cell carcinoma
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Neutrophil-to-lymphocyte ratio (NLR) has been associated with survival in various cancers, including head and neck cancer. However, there is limited information on its role in oropharyngeal squamous cell carcinomas (OPSCC) according to HPV status. This prompted the present meta-analysis. Studies were selected when the prognostic value of NLR prior to treatment was evaluated in OPSCC patients, the cutoff value of NLR was available, and the prognostic value of NLR was evaluated by time-to-event survival analysis. A total of 14 out of 492 articles, including 7647 patients, were analyzed. The results showed a worse prognosis for the patients with a high NLR: The combined hazard ratios (HR) for overall survival (OS) in patients with an elevated NLR was 1.56 (95% confidence interval (CI) 1.21–2.02; p = 0.0006), for disease-free survival was 1.52 (95% CI 1.34–1.73; p < 0.00001), and for recurrence-free survival was 1.86 (95% CI 1.50–2.30; p < 0.00001). This worse prognosis of high NLR was exclusive of HPV-positive patients: HR for OS in the HPV-positive subgroup was 4.05 (95% CI 1.90–8.62 (p = 0.0003), and in the HPV-negative subgroup 0.92 (95% CI 0.47–1.80; p = 0.82). The prognosis of NLR was not influenced by treatment: The HR for OS for patients treated with radiotherapy/chemoradiotherapy (RT/CRT) was 1.48 (95% CI 1.09–2.01; p = 0.01), and for patients treated with surgery (±RT/CRT) was 1.72 (95% CI 1.08–2.72; p = 0.02). In conclusion, an elevated NLR relates to worse outcomes in patients with HPV-positive OPSCC.