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The identification of biomarkers for oncologic outcomes could guide risk-adapted treatment strategies. High neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumours. The aim of this study was to investigate the prognostic value of NLR and PLR in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary or adjuvant (chemo)radiotherapy ((C)RT) and to correlate this parameters to acute toxicity.

A retrospective analysis of 67 consecutive patients with HNSCC was performed. Blood samples were obtained within 15 days before treatment start. Endpoints of interest were overall survival (OS), local recurrence (LR), distant metastasis (DM), and acute toxicity defined according to CTCAE v4. Univariate Cox proportional hazards models were used to study influence of NLR  and PLR used both in the continuum and stratified above and below the median value. To assess differences in median for NLR and PLR for acute toxicity groups we used the Kruscal Wallis test. After grouping the patients with toxicity grade G0 and G1, we used the Mann U-Whitney test to assess differences for the Ratio variables. All statistical analyses were performed using R statistical software (version 3.1.2.).

Sixty-seven patients with HNSCC were considered. All patients were candidate for curative RT intent. Primary CRT was administered in 23 patients (34.3%), primary RT alone in 9 patients (13.4%), adjuvant (C)RT in 35 (52.3%). Tumours were located in: oral cavity 31.3%, larynx 25.4%, oropharynx 23.9%, parotid 7.5%, ear canal 5.9%, hypopharynx 3%, nasopharynx 3%. Median follow-up was 8 months (range: 1-44 months). The median values of pre-treatment NLR and PLR were 1.97 (range: 0.07-16.00) and 121.25 (range: 50-285), respectively. A statistically significant correlation between OS and a PLR value >  of PLR median (p-value=0.053) was found (Table 1). There were no statistically significant correlations between NLR ratio and clinical outcomes (OS, LR, DM). Both NLR and PLR were not associated with acute toxicity, neither acute cutaneous nor total toxicity (Table 2).

The prognostic significance of NLR and PLR have been explored in several cancers. In our study a higher pre-treatment PLR in HNSCC patients resulted predictive of worse OS. The study is still ongoing in order to validate a larger number of patients and to investigate further readily available biomarker helpful to improve pre-treatment prognostication and to define predictive models of risk-stratification.