Peripheral Neutrophil-to-lymphocyte Ratio: A Predictive Marker of Response in Patients of Head-and-neck Cancer Who Underwent Definitive Chemoradiotherapy?

A BSTRACT Background: Neutrophil-to-lymphocyte ratio (NLR) is the most utilized and easily measurable biomarker for evaluating the inflammatory response in different types of solid tumors. Previous studies have demonstrated the prognostic impact of the pretreatment NLR in various types of solid cancers. The purpose of this study is to evaluate the predictive role of NLR in head-and-neck carcinoma (HNC) receiving definitive chemoradiation. Materials and Methods: This retrospective cohort study included 200 patients with nonmetastatic head-and-neck cancer who received definitive chemoradiotherapy from 2018 to 2023. Pretreatment peripheral complete blood count values were retrieved from the patient records. Treatment response was assessed 6–8 weeks’ posttreatment using contrast-enhanced computed tomography of the face and neck, evaluated by the Response Evaluation Criteria in Solid Tumors 1.1. The association between pretreatment NLR and treatment outcome was analyzed. Results: The normal NLR ranges from 0.78 to 3.53 in the general population. A median value of 2.7 was taken as cutoff in our study to classify the patients as high NLR and low NLR. Among 200 patients evaluated 88 patients (44%) had low NLR and 112 patients (56%) had high NLR. Further analysis showed that in patients with low NLR, 27% had complete response, 38% had partial response, 15% had static disease, and 16% had progressive disease as compared to 23%, 44%, 19%, and 12.5% with high-NLR ratio. Conclusion: The study concluded that high-NLR ratio is associated with poor treatment outcome and can be considered as a predictive marker.