Prognosis Value of Platelet Counts, and Neutrophil-Lymphocyte Ratio of Locoregional Recurrence in Patients with Operable Head and Neck Squamous Cell Carcinoma

Abstract

Despite the well-recognized role of blood, inflammatory, and nutritional parameters, several crucial mysteries remain unresolved. To date, there has been limited data on hypopharyngeal and laryngeal cancers. Furthermore, most research has focused on head and neck cancer patients who are either untreated or those receiving definitive chemotherapy. Additionally, it remains unclear whether a single marker has the highest predictive value or if a combination of several markers performs better. In the present study, we investigated the potential relationship between NLR, ALB, PLT, and oncological outcomes in head and neck squamous cell carcinoma, including patients with hypopharyngeal and laryngeal cancers who undergo surgical treatments. Materials and Methods: This descriptive cross-sectional study was conducted over a ten-year period ending in 2024 at Tabriz University of Medical Sciences. The following information was recorded for each patient: age, gender, disease stage (T1, T2, T3, T4), N stage (N0, N1, N2a, N2b, N2c), smoking status, tumor location, type of surgery, neoadjuvant therapy, one-year recurrence, three-year recurrence, five-year recurrence, platelet count, white blood cell count, monocyte count, lymphocyte count, neutrophil count, CRP levels, and ESR levels. After data collection, quantitative analyses were performed. Univariate and multivariate Cox proportional hazards models were used to assess whether these variables were associated with locoregional control (LRC) and cancer-specific survival. Results: For five-year LRC, the area under the ROC curve for NLR was (0.66-0.83: CI95% and OR=0.75) and for PLT was (0.45-0.75: CI95% and OR=0.63). ROC curves indicated that NLR was superior to PLT as a prognostic marker as measured by AUC. The cut-off value for NLR was 3.01, showing sensitivity of 69.3% and specificity of 72% for LRC. The cut-off value for platelet count was 255, with a sensitivity of 32% and specificity of 98.2% for LRC. Correlation between NLR and PLT with prognostic parameters using the log-rank test of actuarial curves showed that five-year LRC (P=0.009) was significantly reduced for patients with NLR less than 3.01. However, there was no statistical difference in cancer survival with NLR greater than 3.01. Similarly, patients with PLT less than 255 exhibited a comparative decrease in five-year LRC (P=0.014). Patients with concurrent NLR greater than 3.01 and PLT greater than 255 had significantly worse oncological outcomes for five years (P=0.001) compared to those with only NLR greater than 3.01 or PLT greater than 255.