High neutrophil-to-lymphocyte ratio predicts poor prognosis in patients with squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy.

AimTo evaluate the role of neutrophil-to-lymphocyte ratio as a prognostic marker in squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy. MethodsA retrospective chart review was performed on patients presenting to our service between 2001 and 2014. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier estimates. The association between neutrophil-to-lymphocyte ratio and survival was analyzed by both univariate and multivariate analysis. ResultsAcross all patients, OS and PFS at 5 years was 59% and 54%, respectively. Increasing T stage correlated with a statistically significant decrease in OS (P = 0.004) and PFS (P = 0.005). Both overall (P = 0.003) and PFS (P = 0.002) were highest in lifetime nonsmokers and lowest in current smokers. Patients who commenced treatment in 2010 or later had a significantly greater overall (P = 0.014) and PFS (P = 0.009) compared to those treated prior. Patients with p16 negative tumors had a significantly lower overall (P<0.001) and PFS (P<0.001) compared to those with p16 positive tumors. Patients treated with cisplatin had an overall and PFS of 66.8% and 59.9% respectively at 5 years. Patients with a neutrophil-to-lymphocyte ratio of less than 4 at treatment initiation had a significantly greater overall (P = 0.015) and PFS (P = 0.017). The trend for OS remained significant in multivariate analysis (P = 0.05). ConclusionA high neutrophil-to-lymphocyte ratio at treatment initiation is a negative predictive marker for squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy.