Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: While advances in these therapies have improved survival rates and mitigated treatment-related morbidity in head and neck cancer (HNC), managing postoperative complications remains critical. These complications can delay or prevent adjuvant therapies, with direct implications for survival outcomes. Identifying reliable predictive markers for adverse events is essential to recognize high-risk patients who might benefit from tailored interventions to improve treatment tolerance and overall survivorship. The neutrophil-to-lymphocyte ratio (NLR), an inflammatory biomarker, has shown promise as a prognostic marker in multiple cancers, with elevated levels linked to worse outcomes. This study evaluates the prognostic value of preoperative NLR in predicting treatment complications, adjuvant therapy tolerance, and 90-day mortality in HNC patients.
Methods: This retrospective cohort study analyzed data from 510 adult HNC patients treated between January 2015 and July 2024 at two university-affiliated hospitals. Eligible patients had primary HNC involving the oral cavity, nasopharynx, oropharynx, hypopharynx, or larynx, with cases managed for both curative and palliative intent. Exclusion criteria included hematologic malignancies. Data collected included demographics, clinical parameters, Charlson Comorbidity Index (CCI) scores, and preoperative NLR values. Patients were stratified into low (≤2.2), moderate (2.2–4.4), and high (>4.4) NLR groups. Logistic regression and Kaplan-Meier survival analyses were used to assess relationships between NLR and outcomes, focusing on postoperative complications, adjuvant therapy tolerance, and 90-day mortality.
Results: Of the 510 HNC patients, 211 had clear surgical margins, 114 had close margins, and 70 had positive margins. Additionally, 132 patients displayed lymphovascular invasion, and CCI scores ranged from 0 to 10, with a median of 4. Analysis of NLR thresholds identified cutoff points for low (≤2.2), moderate (2.2–4.4), and high (>4.4) risk groups, balancing sensitivity and specificity for predicting adverse outcomes. Patients in the high NLR category (>4.4) experienced a significantly greater rate of 30-day postoperative complications (OR = 1.30, p = 0.02) and reduced 90-day survival (HR = 2.07, 95% CI: 1.21–3.54, p = 0.008). Chi-square tests confirmed significant associations between NLR categories and both mortality (χ² = 16.86, p = 0.0002) and disease status (χ² = 20.74, p = 0.002). Kaplan-Meier survival analysis, supported by log-rank testing (p = 0.04), demonstrated significantly shorter complication-free survival in the high NLR group.
Conclusion: Preoperative NLR is a valuable prognostic marker in head and neck cancer, with elevated levels (>4.4) significantly linked to higher rates of postoperative complications and lower short-term survival. Stratifying patients by NLR risk levels (low, moderate, high) allows clinicians to anticipate adverse outcomes more accurately, enabling proactive management in high-risk individuals. These findings endorse the integration of NLR into preoperative assessment protocols, supporting personalized care strategies aimed at enhancing surgical outcomes and survivorship in HNC patients.