Prognostic Nomograms in oral Squamous Cell Carcinoma: The Negative Impact of Low Neutrophil to Lymphocyte Ratio
Prognostic Nomograms in oral Squamous Cell Carcinoma: The Negative Impact of Low Neutrophil to Lymphocyte Ratio
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DOI：
10.3389/fonc.2019.00339
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发表时间：
2019-04-30
影响因子：
4.7
通讯作者：
Nicolai, Piero
中科院分区：
文献类型：
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作者：
Mattavelli, Davide;Lombardi, Davide;Nicolai, Piero
目的：探讨术前中性粒细胞与淋巴细胞比率（NLR）的预后意义以及不同临床病理因素对一系列原发性口腔鳞状细胞癌（OSCC.Materials and Methods）的影响。排除有远处转移、头颈部同步癌、免疫功能紊乱或既往接受过头颈部化疗和/或放疗的患者。主要结局为总体（OS）、疾病特异性（DSS）、局部区域无转移（LRFS）和无远处转移（DMFS）生存率。进行单变量（Kaplan-Meier）和多变量（考克斯回归模型）分析，并为每个结局绘制列线图。采用限制性三次样条多变量考克斯回归模型对NLR进行连续变量分析。LRFS、DMFS、DSS和OS的五年估计值分别为67%、83.7%、69.5%和61.2%。NLR对生存率和复发风险有复杂的影响：非常低和高的值为阴性，而中间比率为阳性。在单因素分析中，T分类、第7 AJCC分期、淋巴结转移、神经周围扩散和淋巴管浸润具有统计学意义。在多变量分析中，结节延伸（ENE）和神经周围扩散是最有力的独立预后因素。NLR是复发风险的独立预测因子。在列线图，NLR和ENE有最强的预后effects.Conclusions：在口腔鳞癌，非常低的术前NLR值有一个负面的预后影响的生存和复发，类似的高比率。ENE和神经周围扩散是最重要的临床病理指标。
Objectives: To investigate the prognostic significance of preoperative neutrophil to lymphocyte ratio (NLR) and the impact of different clinical-pathologic factors in a series of primary oral squamous cell carcinomas (OSCC).Materials and Methods: All naive OSCCs treated with upfront surgery between 2000 and 2014 were retrospectively reviewed. Patients with distant metastasis, synchronous head and neck cancer, immunological disorders, or who had received previous chemotherapy and/or radiation of the head and neck area were excluded. The main outcomes were overall (OS), disease-specific (DSS), loco-regional free (LRFS), and distant metastasis free (DMFS) survivals. Univariate (Kaplan-Meier) and multivariate (Cox regression model) analysis were performed, and nomograms developed for each outcome. NLR was analyzed as a continuous variable using restricted cubic spline multivariable Cox regression models.Results: One-hundred-eighty-two patients were included. Five-year estimates for LRFS, DMFS, DSS, and OS were 67, 83.7, 69.5, and 61.2%, respectively. NLR had a complex influence on survival and risk of recurrence: negative for very low and high values, while positive in case of intermediate ratios. At univariate analysis, T classification, 7th AJCC stage, nodal metastasis, perineural spread, and lymphovascular invasion were statistically significant. At multivariate analysis, extranodal extension (ENE) and perineural spread were the most powerful independent prognostic factors. NLR was an independent prognosticator for the risk of recurrence. In nomograms, NLR and ENE had the strongest prognostic effect.Conclusions: In OSCC, very low preoperative NLR values have a negative prognostic impact on survival and recurrence, similarly to high ratios. ENE and perineural spread are the most important clinical-pathologic prognosticators.