Prognostic value of H-index in patients surgically treated for squamous cell carcinoma of the larynx

Paolo Boscolo-Rizzo; Enrico Zanelli; Fabiola Giudici; Francesca Boscolo-Nata; Giovanni Cristalli; Alberto Deganello; Michele Tomasoni; Cesare Piazza; Paolo Bossi; Giacomo Spinato; Anna Menegaldo; Enzo Emanuelli; Piero Nicolai; Luigia Bandolin; Andrea Ciorba; Stefano Pelucchi; Valentina Lupato; Vittorio Giacomarra; Gabriele Molteni; Daniele Marchioni; Pietro Canzi; Simone Mauramati; Alfonso Fortunati; Margherita Tofanelli; Daniele Borsetto; Jonathan Fussey; Giancarlo Tirelli

doi:10.1002/lio2.603

Prognostic value of H-index in patients surgically treated for squamous cell carcinoma of the larynx

Laryngoscope Investig Otolaryngol. 2021 Jun 23;6(4):729-737. doi: 10.1002/lio2.603. eCollection 2021 Aug.

Authors

Paolo Boscolo-Rizzo¹, Enrico Zanelli¹, Fabiola Giudici², Francesca Boscolo-Nata³, Giovanni Cristalli³, Alberto Deganello⁴, Michele Tomasoni⁴, Cesare Piazza⁴, Paolo Bossi⁵, Giacomo Spinato⁶, Anna Menegaldo⁶, Enzo Emanuelli^{6

7}, Piero Nicolai⁷, Luigia Bandolin⁷, Andrea Ciorba⁸, Stefano Pelucchi⁸, Valentina Lupato⁹, Vittorio Giacomarra⁹, Gabriele Molteni¹⁰, Daniele Marchioni¹⁰, Pietro Canzi¹¹, Simone Mauramati¹¹, Alfonso Fortunati¹, Margherita Tofanelli¹, Daniele Borsetto¹², Jonathan Fussey¹³, Giancarlo Tirelli¹

Affiliations

¹ Department of Medical, Surgical and Health Sciences, Section of Otolaryngology University of Trieste Trieste Italy.
² Department of Medicine, Surgery and Health Sciences University of Trieste Trieste Italy.
³ Unit of Otorhinolaryngology Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta" Monselice Italy.
⁴ Department of Otolaryngology-Head and Neck Surgery University of Brescia Brescia Italy.
⁵ Medical Oncology Unit, Department of Medical Oncology ASST Spedali Civili di Brescia Brescia Italy.
⁶ Unit of Otolaryngology AULSS 2-Marca Trevigiana Treviso Italy.
⁷ Department of Neurosciences, Section of Otolaryngology University of Padova Padova Italy.
⁸ ENT Department University Hospital of Ferrara Ferrara Italy.
⁹ Unit of Otolaryngology Azienda Ospedaliera "S. Maria degli Angeli" Pordenone Italy.
¹⁰ Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Otolaryngology University of Verona Verona Italy.
¹¹ Department of Otolaryngology University of Pavia, IRCCS Policlinico "San Matteo" Foundation Pavia Italy.
¹² Department of ENT, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust Cambridge UK.
¹³ Department of ENT/Head and Neck Surgery University Hospital Birmingham Birmingham UK.

Abstract

Objective: Recently, a novel host-related index, the Host-index (H-index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host-related indexes This study aimed to investigate the prognostic performance of the H-index using pretreatment blood tests in patients receiving up-front surgery for SCC of the larynx.

Methods: This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H-index. Their association with disease-free survival (DFS) and overall survival (OS) was measured.

Results: A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37-96] years; 191 [82.7%] men). The median follow-up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04-1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07-2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21-3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24-4.40) and OS (aHR for death = 2.67; 95% CI: 1.51-4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H-index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65-4.79) and death (2.22; 95% CI: 1.26-3.89).

Conclusion: In conclusion, the present study confirms the prognostic value of pretreatment H-index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx.

Level of evidence: III.

Keywords: H index; inflammation; larynx; prognosis; squamous cell carcinoma.