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

Introduction: 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.

Materials And Methods: NLR and metabolic markers of primary tumor and nodal metastases including maximum standardized uptake value (SUV), 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.

Results: 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=0.47, <0.001; MTV: r=0.40, <0.001; SUV: r=0.34, =0.003), but much less with FDG-PET/CT surrogate markers of metabolic activity in nodal metastases (TLG: r=0.15, =0.19; MTV: r=0.25, =0.034; SUV: r=0.06, =0.63). For nodal positive cancer patients, multivariate analysis showed that an increased NLR (HR=1.19, 95% CI=1.04-1.37, =0.012) and SUV of lymph node metastasis (HR=1.09; 95% CI=0.99-1.19; =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, =0.021).

Conclusion: 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 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.