High Neutrophil-to-Lymphocyte Ratio Combined with Anemia is Associated with Worse Survival in Patients with Laryngeal Squamous Cell Cancer Treated with Radiotherapy

Objectives: We aimed to examine the prognostic value of inflammatory markers such as neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and anemia on oncological outcomes in patients with laryngeal squamous cell carcinomas (LSCC) treated with radiotherapy. Design and setting: Inflammatory markers were established by examining blood samples taken within 7 days before treatment. According to threshold values, the patients were categorized into 2 groups as low and high. In addition, 3 groups were formed with each inflammatory marker and hemoglobin (Hb) level. The relationship between inflammatory markers and overall survival (OS), disease-free survival (DFS), and local regional recurrence-free survival (LRRFS) was investigated. Participants: 213 LSCC patients analyzed retrospectively. Results: The cut-off values of NLR, PLR and SII to predict survival were 2.34, 122 and 564, respectively. In univariate analysis, high NLR, PLR, SII and low Hb (<13 g/dL) level were associated with worse survival (all p<0.022), except for PLR and Hb for LRRFS. OS and DFS were significantly better in patients in each group A with low inflammatory index and high Hb (all p<0.013). In the multivariate analysis, high NLR and group CNLR (high NLR with low Hb) were statistically significant predictors of decreased OS (HR 1.85, 95% CI 1.05-3.28, p=0.033; HR 2.61, 95% CI 1.14-5.97, p=0.022) and DFS (HR 1.81, 95% CI 1.11-2.96, p=0.017; HR 3.32, 95% CI 1.20-9.16, p=0.028). Conclusions: NLR may serve as a potential prognostic biomarker in LSCC, and its predictive ability is further enhanced when NLR is combined with Hb level.