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Prognostic value of post-radiotherapy neutrophil-to-lymphocyte ratio in locally advanced nasopharyngeal carcinoma

  • Dan Ou
  • Xiaoshen Wang
  • Mingyao Wu
  • Fen Xue
  • Yujiao Li
  • Chaosu HuEmail author
  • Xiayun HeEmail author
Original Article

Abstract

Purpose

To explore the temporal profile of the peripheral neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced nasopharyngeal carcinoma (LANPC) and the potential prognostic value of its dynamic changes.

Methods

Complete blood count of 112 patients from a previous phase II study were retrospectively collected at the timepoints of the initiation of induction chemotherapy (pre-IC), within 1 week before radiotherapy started (pre-RT), and within 1 week after radiotherapy finished (post-RT). Data of 103 patients were fully recorded and Cox regression analysis was used to analyze the correlations of potential risk factors with 5‑year overall survival (OS). The performance of the prognostic factor was validated in another independent cohort of 103 matched (by T and N stage) patients selected from 236 consecutive NPC patients treated with IC and concurrent chemoradiation.

Results

Multivariate analysis (MVA) identified patient age >50 years old (hazard ratio [HR] = 3.4, p = 0.02), weight loss during RT >7.5% (HR = 3.2, p = 0.03), and post-RT peripheral NLR >7.05 (vs. NLR ≤7.05, HR = 2.5, p = 0.04, 5‑year OS 71.4% vs. 87.8%) as unfavorable prognostic factors for OS. There was also a non-significant trend in the MVA that patients with post-RT peripheral NLR >7.05 showed worse progression-free survival (PFS; HR = 1.9, p = 0.06, 5‑year PFS 64.1% vs. 81.8%). Post-RT NLR had a good prognostic performance in the validation cohort (concordance index = 0.73, standard error 0.10; p = 0.02, Wilcoxon test).

Conclusion

Post-RT NLR is an independent prognostic factor for OS in LANPC patients. The dynamic change of the routinely tested inflammatory variable could help selection of appropriate treatment options and follow-up strategies.

Keywords

Neutrophil-to-lymphocyte ratio Complete blood count Nasopharyngeal carcinoma Prognostic factor Radiotherapy 

Prognostischer Wert des Verhältnisses von Neutrophilen zu Lymphozyten nach Strahlentherapie bei lokal fortgeschrittenem Nasopharynxkarzinom

Zusammenfassung

Zweck

Untersuchung des zeitlichen Verlaufs der peripheren NLR („neutrophil-to-lymphocyte ratio“) bei Patienten mit lokal fortgeschrittenem Nasopharynxkarzinom (LANPC) und des potenziellen prognostischen Werts seiner dynamischen Veränderungen.

Methoden

Das vollständige Blutbild von 112 Patienten aus einer früheren Phase-II-Studie wurde zum Zeitpunkt des Beginns der Induktionschemotherapie (Pre-IC), innerhalb einer Woche vor Beginn der Strahlentherapie (Pre-RT) und innerhalb einer Woche nach beendeter Strahlentherapie (post-RT) retrospektiv erhoben. Die Daten von 103 Patienten wurden vollständig aufgezeichnet und die Cox-Regressionsanalyse wurde verwendet, um die Korrelationen des potenziellen Risikofaktors mit dem 5‑Jahres-Gesamtüberleben (OS) zu analysieren. Die Leistung des Prognosefaktors wurde in einer anderen unabhängigen Kohorte von 103 (nach T‑ und N‑Stadium) passenden Patienten validiert, die aus 236 konsekutiven NPC-Patienten ausgewählt wurden, die mit IC und gleichzeitiger Radiochemotherapie behandelt wurden.

Ergebnisse

Die multivariate Analyse (MVA) identifizierte ein Patientenalter >50 Jahre (Hazard Ratio [HR] = 3,4; p = 0,02), einen Gewichtsverlust während RT >7,5% (HR = 3,2; p = 0,03) und eine periphere NLR nach RT >7,05 (NLR ≤7,05; HR = 2,5; p = 0,04; 5‑Jahres-OS 71,4% vs. 87,8%) als ungünstige Prognosefaktoren für das OS. Es gab auch einen nichtsignifikanten Trend in der MVA, dass Patienten mit peripherer NLR nach RT >7,05 ein schlechteres progressionsfreies Überleben (PFS) zeigten (HR = 1,9; p = 0,06; 5‑Jahres-PFS 64,1% vs. 81,8%). Post-RT-NLR zeigte eine gute Prognoseleistung in der Validierungskohorte (Konkordanzindex = 0,73, Standardfehler 0,10; p = 0,02, Wilcoxon-Test).

Schlussfolgerung

Post-RT-NLR ist ein unabhängiger Prognosefaktor für das OS bei LANPC-Patienten. Die dynamische Änderung der routinemäßig getesteten entzündlichen Variablen könnte dazu beitragen, geeignete Behandlungsoptionen und Follow-up-Strategien zu entwickeln.

Schlüsselwörter

Verhältnis von Neutrophilen zu Lymphozyten Komplettes Blutbild Nasopharynxkarzinom Prognosefaktor Strahlentherapie 

Notes

Funding

This study was supported by the Shanghai Anticancer Association EYAS PROJECT (grant no: SACA-CY1A02) and an institutional grant from the Fudan University Shanghai Cancer Center (grant no: YJ201703).

Conflict of interest

D. Ou, X. Wang, M. Wu, F. Xue, Y. Li, C. Hu, and X. He declare that they have no competing interests.

Supplementary material

66_2019_1529_MOESM1_ESM.docx (941 kb)
In Supplemental Table 1 we provide the baseline clinicopathological characteristics of the 133 discarded patients from the validation cohort. In Supplemental Table 2 and Supplemental Figure 1, we provide data of NLR and EBV DNA of another group of 80 patients treated between May 2018 and March 2019 in our department, to provide an idea about the NLR range and preliminary result of the correlation between EBV DNA and NLR.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina

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