Assessment of Neutrophil-to-Lymphocyte Ratio as A Prognostic Marker in Locally Advanced Head and Neck Cancer Treated with Concomitant Chemoradiation

Abstract

Abstract Background Various experimental and epidemiological studies have been conducted to find the relationship between hematologic parameters like neutrophil-to-lymphocyte ratio (NLR) and prognosis in numerous solid malignancies. We conducted a similar study to assess the role of NLR as a prognostic marker in locally advanced head and neck cancer (HNC) treated with chemoradiation. Patients and methods A total of 60 patients of histopathologically proven, previously untreated, locally advanced HNC were included in this randomized, prospective study. They were stratified into five groups according to their NLR values (<2, 2–3, 3–4, 4–5, and >5). All 60 patients received the same concurrent chemoradiation with a radiation dose of 66 Gy in 33 fractions over 6.5 weeks with injection cisplatin 40 mg/m2 weekly. Treatment-related toxicities were assessed weekly. Association of NLR was assessed with the outcomes as per the World Health Organization (WHO) response criteria. Informed consent was taken from all patients, and approval of institutional ethical committee was obtained. Results Complete response was observed to be maximum in patients with low NLR value of <2 (73% of patients). Higher percentage of treatment-related toxicities was also observed in groups with higher NLR values, that is, NLR 4–5 and >5. The association of NLR with treatment response was statistically significant on Pearson's chi-square test (P = 0.019). Conclusion Our study was able to establish the relationship between NLR and treatment outcome in HNC patients treated by concurrent chemoradiation. Higher pretreatment NLR values were associated with poorer survival outcomes and increased treatment-induced toxicities.