High neutrophil-to-lymphocyte ratio predicts poor prognosis in patients with squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy

Aim: To evaluate the role of neutrophil-to-lymphocyte ratio as a prognostic marker in squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy. Methods: A retrospective chart review was performed on patients presenting to our service between 2001 and 2014. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan–Meier estimates. The association between neutrophil-to-lymphocyte ratio and survival was analyzed by both univariate and multivariate analysis. Results: Across all patients, OS and PFS at 5 years was 59% and 54%, respectively. Increasing T stage correlated with a statistically significant decrease in OS (P = 0.004) and PFS (P = 0.005). Both overall (P = 0.003) and PFS (P = 0.002) were highest in lifetime nonsmokers and lowest in current smokers. Patients who commenced treatment in 2010 or later had a significantly greater overall (P = 0.014) and PFS (P = 0.009) compared to those treated prior. Patients with p16 negative tumors had a significantly lower overall (P < 0.001) and PFS (P < 0.001) compared to those with p16 positive tumors. Patients treated with cisplatin had an overall and PFS of 66.8% and 59.9% respectively at 5 years. Patients with a neutrophil-to-lymphocyte ratio of less than 4 at treatment initiation had a significantly greater overall (P = 0.015) and PFS (P = 0.017). The trend for OS remained significant in multivariate analysis (P = 0.05). Conclusion: A high neutrophil-to-lymphocyte ratio at treatment initiation is a negative predictive marker for squamous cell carcinoma of the head and neck treated with definitive chemoradiotherapy.