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Inflammation and inflammatory markers, when associated with cancer have been shown to have a worse prognosis. As systemic inflammation leads to alteration in the peripheral blood leukocytes, Neutrophil to Lymphocyte Ratio (NLR) is a proxy measurement of the degree of inflammation. Similarly, platelets release pro-inflammatory mediators, such as cytokines, which exacerbate the inflammatory microenvironment in tumors, making Platelet Lymphocyte Ratio (PLR) another marker. This study aims to determine the impact of pre-treatment NLR and PLR on treatment outcome and its correlation with sarcopenia in locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC) patients treated with definitive chemoradiotherapy.

Two hundred and forty patients of locally advanced HNSCC were included in this retrospective study. All patients were treated with radical radiotherapy dose of 70Gy/35# over 7 weeks along with concurrent chemotherapy. The pre-treatment neutrophil, lymphocyte and platelet counts were recorded and NLR and PLR were calculated. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscle mass at level C3. The impact of NLR and PLR on treatment outcome (Complete Response Rate) (CRR) and Disease Free Survival (DFS) were calculated. The median follow up of the patients was 18 months.

The mean age of the study was 61 years. Mean NLR and PNR were 4.15 and 176.14 respectively. NLR and PLR were significantly higher in elderly patients (>60 years) and female gender. Amongst sub-sites NLR and PLR was highest in laryngeal primary followed by hypopharynx and oropharynx. Patients with complete response had lower mean NLR and PLR values as compared to those without complete response (2.9/ 142.19 vs. 5.3/ 209.8). The average SMI of the entire patient cohort was 31.9 cm²/m². As per cut of calculated from ROC curve, patients with SMI of >32 cm²/m² fared better than SMI<32 cm²/m². Patients with significant sarcopenia (SMI< 32 cm²/m²) had a higher mean NLR value as compared to those with SMI>32 cm²/m² (4.73 vs. 3.5). There is a negative correlation between NLR and SMI (p value: 0.08). The ROC curve cut off value for NLR and PLR were 3 and 145 respectively. Patients with NLR<3 had a favorable outcome with CRR being 62% with average SMI of 34. Patients with NLR> 3 had poorer outcome with CRR being 38% and an average SMI of 30. The odds of having sarcopenia in such cases was 1.2. Patients with PLR<145 had a CRR of 59.5% while it was 39.6% with PLR > 145. DFS was higher in patients with lower NLR (20 months vs. 14 months). Similarly DFS was higher in patients with lower PLR (18 months vs. 15 months). 

Inflammatory markers like NLR and PLR in HNSCC patients receiving definitive chemoradiotherapy are independent prognostic factors. Higher NLR and PLR is associated with sarcopenia and worse treatment outcomes. These tumors tend to be more aggressive as well.