Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer

Nikhil V Kotha; Rohith S Voora; Alex S Qian; Abhishek Kumar; Edmund M Qiao; Tyler F Stewart; Brent S Rose; Ryan K Orosco

doi:10.1177/11772719211049848

Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer

Biomark Insights. 2021 Oct 11:16:11772719211049848. doi: 10.1177/11772719211049848. eCollection 2021.

Authors

Nikhil V Kotha^{1

2

3}, Rohith S Voora^{1

2

4}, Alex S Qian^{1

3}, Abhishek Kumar^{2

5}, Edmund M Qiao^{1

2

3}, Tyler F Stewart^{6

7}, Brent S Rose^{2

3

7}, Ryan K Orosco^{2

4

7}

Affiliations

¹ School of Medicine, University of California San Diego, La Jolla, CA, USA.
² Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
³ Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA.
⁴ Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, La Jolla, CA, USA.
⁵ Department of Radiation Oncology, Duke University, Durham, NC, USA.
⁶ Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
⁷ Moores Cancer Center at University of California San Diego Health, La Jolla, CA, USA.

Abstract

Purpose: Neutrophil-lymphocyte ratio has been explored as a prognosticator in several cancer types, but its association with larynx cancer outcomes is not well known. We aimed to identify an optimal NLR cutoff point and examine the prognostic utility of this biomarker in patients with locoregionally advanced larynx cancer treated with curative intent.

Methods: In the Veterans Affairs' (VA) national database, we identified patients with locoregionally advanced (T3-4N0-3M0) laryngeal squamous cell carcinoma diagnosed between 2000 and 2017 and treated with curative intent. NLR cutoff points were calculated using Contal/O'Quigley's method. Outcomes of larynx cancer-specific survival (CSS), overall survival (OS), and non-larynx cancer survival (NCS) were evaluated in multivariable Cox and Fine-Gray models.

Results: In 1047 patients, the optimal pretreatment NLR cutoff was identified as 4.17 - 722 patients with NLR ⩽ 4.17, 325 patients with NLR > 4.17. The elevated NLR cohort had a higher proportion of T4 disease (39.4% vs 28.4%), node positive disease (52.3% vs 43.1%), and surgical treatment (43.7% vs 35.2%). In multivariable analysis, NLR > 4.17 was independently associated with worse OS (HR 1.31, 95% CI 1.12-1.54, P = .001) and worse CSS (HR 1.46, 95% CI 1.17-1.83, P < .001), but not with NCS (HR 0.94, 95% CI 0.75-1.18, P = .58).

Conclusion: In locoregionally advanced larynx cancer treated with curative intent, we identified elevated NLR to be associated with inferior OS and CSS. Further prospective studies are needed to investigate pretreatment NLR and our identified 4.17 cutoff as a potential larynx cancer-specific marker for this high risk population.

Keywords: Neutrophil-lymphocyte ratio; Veterans Affairs (U.S.); laryngeal squamous cell carcinoma; prognostic factors.