The Prognostication of Surgically Resected Head and Neck Squamous Cell Carcinoma Using Pre-Therapy Neutrophil and Lymphocyte Counts.

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2024-10-16 DOI:10.1002/hed.27949

Pranit R Sunkara, Emily Chow, Jacob Waitzman, Ammar Sukari, John D Cramer

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Abstract

Background: Hematological markers, such as neutrophils (ANC), lymphocyte (ALC), and neutrophil-lymphocyte ratio (NLR), may serve as indicators of systemic inflammation and immune response in head and neck squamous cell carcinoma (HNSCC). However, their prognostic significance across HNSCC subtypes remains to be fully elucidated.

Methods: We conducted a secondary analysis of a randomized clinical trial involving patients with surgically resected HNSCC with either positive margins or extranodal extension. These patients received either adjuvant chemoradiation with or without lapatinib. We explored the correlation between pre-therapy ANC, ALC, and NLR levels and overall survival (OS) as well as disease-free survival (DFS). A sub-group analysis examined potential links between these markers, primary tumor location, and HPV status.

Results: Of the 688 patients in the trial, we included 681 patients with documented pre-therapy ANC and ALC values. High pre-therapy ANC and ALC were significantly associated with reduced OS (HR, 1.56; 95% CI: 1.19-2.05) and (HR, 1.34; 95% CI: 1.01-1.79), respectively. High NLR did not significantly affect OS (HR, 1.09; 95% CI: 0.81-1.47). Subgroup analysis indicated significantly reduced OS in patients with high ANC across oropharyngeal, non-oropharyngeal, and HPV-negative subtypes. High ANC, ALC, and NLR did not impact DFS notably.

Conclusion: Elevated pre-therapy ANC is strongly associated with decreased survival across all patients and subgroups, ALC was only significant in the general patient analysis. NLR's association with reduced OS was not statistically significant. These biomarkers may provide greater prognostic value in patients with oropharyngeal cancer and seemed to be more strongly associated with OS than DFS.

Trial registration: Clinicaltrials.gov identifier: NCT00424255; URL: https://clinicaltrials.gov/ct2/show/study/NCT00424255.

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利用治疗前中性粒细胞和淋巴细胞计数对手术切除的头颈部鳞状细胞癌进行预诊

背景：中性粒细胞（ANC）、淋巴细胞（ALC）和中性粒细胞-淋巴细胞比值（NLR）等血液学指标可作为头颈部鳞状细胞癌（HNSCC）全身炎症和免疫反应的指标。然而，它们在不同亚型 HNSCC 中的预后意义仍有待全面阐明：我们对一项随机临床试验进行了二次分析，该试验涉及经手术切除、边缘阳性或结节外扩展的 HNSCC 患者。这些患者接受了有或没有拉帕替尼的辅助化疗。我们探讨了治疗前ANC、ALC和NLR水平与总生存期（OS）和无病生存期（DFS）之间的相关性。一项亚组分析研究了这些标志物、原发肿瘤位置和HPV状态之间的潜在联系：在参与试验的 688 名患者中，我们纳入了 681 名治疗前有 ANC 和 ALC 值记录的患者。高治疗前ANC和ALC分别与OS降低（HR，1.56；95% CI：1.19-2.05）和（HR，1.34；95% CI：1.01-1.79）显著相关。高NLR对OS无明显影响（HR，1.09；95% CI：0.81-1.47）。亚组分析显示，在口咽、非口咽和HPV阴性亚型中，高ANC患者的OS明显降低。高ANC、ALC和NLR对DFS没有明显影响：结论：在所有患者和亚组中，治疗前ANC升高与生存率下降密切相关，ALC仅在普通患者分析中具有显著性。NLR与OS下降的关系在统计学上并不显著。这些生物标志物可能对口咽癌患者具有更大的预后价值，而且与OS的相关性似乎比与DFS的相关性更强：试验注册：Clinicaltrials.gov identifier：NCT00424255; url: https://clinicaltrials.gov/ct2/show/study/NCT00424255.

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.