AUTHOR=Werner Jonas , Strobel Klaus , Lehnick Dirk , Rajan Gunesh P. 

TITLE=Overall Neutrophil-to-Lymphocyte Ratio and SUVmax of Nodal Metastases Predict Outcome in Head and Neck Cancer Before Chemoradiation

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.679287

DOI=10.3389/fonc.2021.679287

ISSN=2234-943X

ABSTRACT=<sec><title>Introduction</title><p>This study investigates the pretherapeutic neutrophil-to-lymphocyte ratio (NLR) with markers of tumor metabolism in 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and their potential prognostic value in head and neck cancer patients prior to primary chemoradiation.</p></sec><sec><title>Materials and Methods</title><p>NLR and metabolic markers of primary tumor and nodal metastases including maximum standardized uptake value (SUV<sub>max</sub>), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were retrospectively assessed in a consecutive cohort of head and neck squamous cell cancer patients undergoing primary chemoradiation. The main outcome measure was survival.</p></sec><sec><title>Results</title><p>The study included 90 patients of which 74 had lymph node metastases at diagnosis. Median follow-up time of nodal positive patients (n=74) was 26.5 months (IQR 18–44). The NLR correlated significantly with metabolic markers of the primary tumor (TLG: r<sub>s</sub>=0.47, <italic>P</italic>&lt;0.001; MTV: r<sub>s</sub>=0.40, <italic>P</italic>&lt;0.001; SUV<sub>max</sub>: r<sub>s</sub>=0.34, <italic>P</italic>=0.003), but much less with FDG-PET/CT surrogate markers of metabolic activity in nodal metastases (TLG: r<sub>s</sub>=0.15, <italic>P</italic>=0.19; MTV: r<sub>s</sub>=0.25, <italic>P</italic>=0.034; SUV<sub>max</sub>: r<sub>s</sub>=0.06, <italic>P</italic>=0.63). </p><p>For nodal positive cancer patients, multivariate analysis showed that an increased NLR (HR=1.19, 95% CI=1.04-1.37, <italic>P</italic>=0.012) and SUV<sub>max</sub> of lymph node metastasis (HR=1.09; 95% CI=0.99-1.19; <italic>P</italic>=0.081) are independently predictive of disease-specific survival. High NLR had a negative prognostic value for overall survival (HR=1.16, 95% CI=1.02-1.33, <italic>P</italic>=0.021).</p></sec><sec><title>Conclusion</title><p>NLR correlates positively with metabolic markers of the primary tumor, suggestive of an unspecific inflammatory response in the host as a possible reflection of increased metabolism of the primary tumor. SUV<sub>max</sub> of lymph node metastases and the NLR, however, show no correlation and are independently predictive of disease-specific survival. Therefore, their addition could be used to improve survival prediction in nodal positive head and neck cancer patients undergoing primary chemoradiation.</p></sec>