1. This single-centred, observational cohort study demonstrated that among patients with head and neck cancer, a high neutrophil-lymphocyte ratio (NLR) was associated with worse overall survival and cancer-specific survival at three years compared to a low NLR.

2. High NLR was associated with worse T and N cancer staging and poorer performance status compared to low NLR.

Evidence Rating Level: 2 (Good)

Study Rundown: Given that inflammation is known to contribute to cancer progression, certain biomarkers can be utilized as a prognostication tool for solid tumours. Elevated neutrophil-lymphocyte ratio (NLR) is a poor prognostic marker for survival outcomes among patients with head and neck cancers in several studies. However, many of these studies have limitations and may not generalize to patients in the United States. This single-centred, observational cohort study examined the association of NLR and survival outcomes among nonmetastatic head and neck cancer patients who received chemoradiation. There were 496 patients included from April 2007 to March 2021. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS). The threshold of NLR (high vs. low) was calculated to be 5.71 using maximum log-rank statistics. At 3 years, OS was 77.3% (95% CI: 73.1-81.7) versus 43.0% (95% CI: 30.6-60.3) and CSS was 83.4% (95% CI: 79.5-87.4) versus 55.6% (95% CI: 42.9-71.9) in the low and high NLR cohorts, respectively. As a result, Cox multivariable analysis demonstrated significantly worse OS (adjusted hazard ratio [aHR]: 1.97 [95% CI: 1.26-3.09]) and CSS (aHR: 2.33 [95% CI: 1.38-3.95]) in the high NLR cohort. Additionally, patients with higher T and N staging for their cancers were significantly more likely to have a high NLR. Patients noted to have a good performance status were less likely to have high NLR. Overall, this cohort study of patients with head and neck cancer who received chemoradiation demonstrated that high NLR was a negative prognostic factor, including poor survival outcomes, tumour staging, and performance status. This study was limited by its sample, which consisted mainly of White (87.1%) and male (82.9%) patients, reducing the generalizability of its findings.

Click to read the study in JAMA Network Open

Relevant Reading: Neutrophil-to-lymphocyte ratio in head and neck cancer prognosis: a systematic review and meta-analysis

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