Baseline derived neutrophil to lymphocyte ratio predicting the prognosis of local advanced oral squamous cell carcinoma: a retrospective study over 10 years

doi:10.19438/j.cjoms.2023.06.006

Abstract

Abstract: PURPOSE: To investigate the value of derived neutrophils to lymphocyte ratio (dNLR) in predicting the survival and prognosis of patients with locally advanced oral squamous cell carcinoma(LAOSCC). METHODS: Patients of stage Ⅲ/ⅣA LAOSCC disease who accepted radical surgery and postoperative radiotherapy from a phase Ⅲ trial (NCT01542931) were enrolled. Based on their baseline clinical data and ten-year-follow-up visiting data, receiver operating characteristic curves (ROC) were built and area under the curve (AUC) was computed to determine dNLR cutoff points, according to Youden's index. The patients were then grouped into low dNLR group and high dNLR group. Kaplan-Meier estimates of survival and Cox proportional hazards models were used for longitudinal analysis. The primary outcome was overall survival (OS). The second outcome was disease-free survival(DFS), local recurrence-free survival(LRFS) and distant metastasis-free survival(DMFS). SPSS 25.0 software package was used for data analysis. RESULTS: A total of 115 patients with LAOSCC were enrolled in this study, with an average age of (54.5±10.7) years and an average follow-up time of (80.3±55.5) months. dNLR cutoff point was 1.555. Multivariate analysis showed dNLR was an independent negative predictive factor for survival (OS: HR=1.172, 95%CI: 1.028-1.337, P=0.018; DFS: HR=1.123, 95%CI: 1.001-1.282, P=0.050; LRFS: HR=1.137, 95%CI: 1.002-1.291, P=0.047; DMFS: HR=1.162, 95%CI: 1.020-1.324, P=0.024). CONCLUSIONS: dNLR is an independent negative predictive factor in patients with LAOSCC. Patients of lower baseline dNLR achieve better long-term prognosis.

Key words: Derived neutrophils to lymphocyte ratio, dNLR, Locally advanced oral squamous cell carcinoma, Prognosis

CLC Number:

R739.8

ZHU Fang-xing, ZHOU Zhi-hang, JU Wu-tong, TAN Yi-ran, LIU Ying, ZHONG Lai-ping, ZHAO Tong-chao. Baseline derived neutrophil to lymphocyte ratio predicting the prognosis of local advanced oral squamous cell carcinoma: a retrospective study over 10 years[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(6): 566-571.

References

[1] Caudell JJ, Gillison ML, Maghami E, et al.NCCN Guidelines^® Insights: head and neck cancers, version 1.2022[J]. J Natl Compr Canc Netw, 2022, 20(3): 224-234.
[2] Zhao TC, Liang SY, Ju WT, et al.Normal BMI predicts the survival benefits of inductive docetaxel, cisplatin, and 5-fluorouracil in patients with locally advanced oral squamous cell carcinoma[J]. Clin Nutr, 2020, 39(9): 2751-2758.
[3] Zhao TC, Liang SY, Ju WT, et al.High-risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer[J]. J Oral Pathol Med, 2020, 49(8): 787-795.
[4] Alessi JV, Ricciuti B, Alden SL, et al.Low peripheral blood derived neutrophil-to-lymphocyte ratio (dNLR) is associated with increased tumor T-cell infiltration and favorable outcomes to first-line pembrolizumab in non-small cell lung cancer[J]. J Immunother Cancer, 2021, 9(11): e003536.
[5] Kazandjian D, Gong Y, Keegan P, et al.Prognostic value of the lung immune prognostic index for patients treated for metastatic non-small cell lung cancer[J]. JAMA Oncol, 2019, 5(10): 1481-1485.
[6] Ferrucci PF, Ascierto PA, Pigozzo J, et al.Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab[J]. Ann Oncol, 2016, 27(4): 732-738.
[7] Capone M, Giannarelli D, Mallardo D, et al. Baseline neutrophil-to-lymphocyte ratio (NLR) andderived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab[J]. J Immunother Cancer, 2018, 16, 6(1): 74-80.
[8] van Soest RJ, Templeton AJ, Vera-Badillo FE, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker for men with metastatic castration-resistant prostate cancer receiving first-line chemotherapy: data from two randomized phase Ⅲ trials[J]. Ann Oncol, 2015, 26(4):743-749.
[9] Bauckneht M, Rebuzzi SE, Signori A, et al.The prognostic power of inflammatory indices and clinical factors in metastatic castration-resistant prostate cancer patients treated with radium-223 (BIO-Ra study)[J]. Eur J Nucl Med Mol Imaging, 2022, 49(3): 1063-1074.
[10] Rebuzzi SE, Signori A, Banna GL, et al.Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study)[J]. Ther Adv Med Oncol, 2021, 13: 17588359211019642.
[11] Grenader T, Nash S, Adams R, et al.Derived neutrophil lymphocyte ratio is predictive of survival from intermittent therapy in advanced colorectal cancer: a post hoc analysis of the MRC COIN study[J]. Br J Cancer, 2016, 114(6): 612-615.
[12] Colloca GA, Venturino A, Guarneri D.Reduction of derived neutrophil-to-lymphocyte ratio after four weeks predicts the outcome of patients receiving second-line chemotherapy for metastatic colorectal cancer[J]. Cancer Immunol Immunother, 2021, 70(4):1115-1125.
[13] Dalpiaz O, Pichler M, Mannweiler S, et al.Validation of the pretreatment derived neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma[J]. Br J Cancer, 2014, 110(10): 2531-2516.
[14] Casadei-Gardini A, Rimini M, Kudo M, et al.Real life study of lenvatinib therapy for hepatocellular carcinoma: relevant study[J]. Liver Cancer, 2022, 11(6): 527-539.
[15] Fiore M, Ljevar S, Pasquali S, et al.Preoperative Neutrophil-to-lymphocyte ratio and a new inflammatory biomarkers prognostic index for primary retroperitoneal sarcomas[J]. Clin Cancer Res, 2023, 29(3): 614-620.
[16] Sui Q, Zhang X, Chen C, et al.Inflammation promotes resistance to immune checkpoint inhibitors in high microsatellite instability colorectal cancer[J]. Nat Commun, 2022, 13: 7316-7326.
[17] Mezquita L, Preeshagul I, Auclin E, et al.Predicting immunotherapy outcomes under therapy in patients with advanced NSCLC using dNLR and its early dynamics[J]. Eur J Cancer, 2021, 151: 211-220.
[18] Abbate V, Barone S, Troise S, et al.The combination of inflammatory biomarkers as prognostic indicator in salivary gland malignancy[J]. Cancers (Basel), 2022, 14(23): 5934-5946.
[19] Cho U, Sung YE, Kim MS, et al.Prognostic role of systemic inflammatory markers in patients undergoing surgical resection for oral squamous cell carcinoma[J]. Biomedicines, 2022, 10(6):1268-1282.
[20] Li X, Sun W, Ding X, et al.Prognostic model of immune checkpoint inhibitors combined with anti-angiogenic agents in unresectable hepatocellular carcinoma[J]. Front Immunol, 2022, 13:1060051.
[21] Kachuri L, Jeon S, DeWan AT, et al. Genetic determinants of blood-cell traits influence susceptibility to childhood acute lymphoblastic leukemia[J]. Am J Hum Genet, 2021, 108(10):1823-1835.
[22] Sano Y, Kogashiwa Y, Araki R, et al.Correlation of inflammatory markers, survival, and COX2 expression in oral cancer and implications for prognosis[J]. Otolaryngol Head Neck Surg, 2018, 158(4): 667-676.
[23] Zubair F, McMahon J, Kryklyas G, et al. Systemic inflammatory response in predicting outcomes of patients undergoing curative resection for oral squamous cell carcinoma[J]. Br J Oral Maxillofac Surg, 2022, 60(5): 589-595.
[24] Ruiz-Ranz M, Lequerica-Fernández P, Rodríguez-Santamarta T, et al.Prognostic implications of preoperative systemic inflammatory markers in oral squamous cell carcinoma, and correlations with the local immune tumor microenvironment[J]. Front Immunol, 2022, 13: 941351.
[25] Kosec A, Solter D, Ribic A, et al.Systemic inflammatory markers as predictors of postoperative complications and survival in patients with advanced head and neck squamous cell carcinoma undergoing free-flap reconstruction[J]. J Oral Maxillofac Surg, 2022, 80(4): 744-755.
[26] Xiong Y, Zhao N, Zheng Y, et al.Prognostic value of pretreatment inflammatory biomarkers in advanced lung adenocarcinoma patients receiving first-line pemetrexed/platinum doublet[J]. Tumour Biol, 2017, 39(6): 1010428317701639.
[27] Winarto H, Habiburrahman M, Anggraeni TD, et al.The utility of pre-treatment inflammation markers as associative factors to the adverse outcomes of vulvar cancer: a study on staging, nodal involvement, and metastasis models[J]. J Clin Med, 2022, 12(1): 96-120.