Exploring the role of neutrophil-to-lymphocyte ratio and blood chemistry in head and neck adenoid cystic carcinomas treated with carbon ion radiotherapy

Amelia Barcellini; Giulia Fontana; Daria Maria Filippini; Sara Ronchi; Maria Bonora; Barbara Vischioni; Rossana Ingargiola; Anna Maria Camarda; Pierre Loap; Nadia Facchinetti; Lisa Licitra; Guido Baroni; Ester Orlandi

doi:10.1016/j.radonc.2022.10.027

Exploring the role of neutrophil-to-lymphocyte ratio and blood chemistry in head and neck adenoid cystic carcinomas treated with carbon ion radiotherapy

Radiother Oncol. 2022 Dec:177:143-151. doi: 10.1016/j.radonc.2022.10.027. Epub 2022 Oct 31.

Affiliations

¹ Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
² Clinical Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
³ Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy.
⁴ Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy. Electronic address: sara.ronchi@cnao.it.
⁵ Department of Radiation Oncology, Institut Curie, Paris, France.
⁶ Scientific Direction, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁷ Scientific Direction, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Head and Neck Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
⁸ Clinical Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy.

PMID: 36328091
DOI: 10.1016/j.radonc.2022.10.027

Abstract

Background and purpose: In recent years, there is an emerging interest in the prognostic role of chemistry blood biomarkers in oncological patients but their role in adenoid cystic carcinomas (ACCs) is still unknown. This study aims to assess the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) and blood chemistry in a series of head and neck ACC patients treated with carbon ion radiotherapy (CIRT).

Material and methods: We retrospectively retrieved the data of 49 consecutive head and neck ACC patients treated with CIRT. Univariable and multivariable Cox proportional hazard regression (Cox-ph) analyses were performed to look for a potential association of NLR, and other blood biomarker values, with disease-free survival (DFS), Local Control (LC), Metastasis Free Survival (MFS) and overall survival (OS).

Results: No significant association between NLR > 2,5 and DFS, LC, MFS and OS was found with univariable analysis although a trend was reported for DFS (Hazard ratio [HR]: 2,10, 95 % CI: 0,85 - 5,08, p-value = 0,11). Patients with hemoglobin (hb) ≤ 14 g/dL showed significantly better DFS, MFS and OS. Multivariable regression Cox-ph analysis for DFS, adjusted for margin status, clinical target volume and Absolute Number of Monocytes, reported the following statistically significant HRs, for both NLR > 2,5 and hb > 14 g/dL respectively: 4,850 (95 % CI = 1,408 - 16,701, p = 0,012) and 3,032 (95 % CI = 1,095 - 8,393, p = 0,033). Moreover, hb > 14 with HR = 3,69 (95 % CI: 1,23 - 11,07, p-value = 0,02), was a negative independent prognostic predictor for MFS.

Conclusions: Pre-treatment NLR and hb values seem to be independent prognostic predictor for clinical outcomes in head and neck ACC patients. If their role will be validated in a larger prospective cohort, they might be worthwhile for a pre-treatment risk stratification in patients treated with CIRT.

Keywords: Adenoid cystic carcinoma; Carbon ion radiotherapy; Hemoglobin; NLR; Neutrophil-to-lymphocyte ratio.

MeSH terms

Carcinoma, Adenoid Cystic* / radiotherapy
Heavy Ion Radiotherapy*
Humans
Lymphocyte Count
Lymphocytes
Neutrophils
Prognosis
Prospective Studies
Retrospective Studies