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Published on: October 24, 2025
Preoperative Neutrophil-to-Lymphocyte Ratio Predicts Recurrence in HPV-Associated Oropharyngeal Cancer After
Micah K Harris1, Kelly Daniels1, Vanessa Helou1
1Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Objective:
Evaluate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) as a predictor of survival outcomes after transoral robotic surgery (TORS) for human papillomavirus-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC).
Study Design:
Single-institution retrospective review of patients who underwent TORS for HPV + OPSCC from April 2014 to October 2021 and had a preoperative complete blood count test.
Setting:
Tertiary academic center.
Methods:
Preoperative NLR was calculated from complete blood counts drawn within 1 month prior to surgery. Receiver operating characteristic curves evaluated performance of prognostic markers. Kaplan-Meier estimator and Cox regression analyses were used to evaluate survival outcomes when controlling for confounding variables.
Results:
A total of 117 patients were included (85.5% male, 94.0% Caucasian, 59.6 ± 9.1 years old), of which 13 patients (11.1%) recurred at a median of 23.5 ± 23 months, including 7 distant metastases. At the latest follow-up, 90.6% remained alive. On Kaplan-Meier analyses, a preoperative NLR of >2.2 was associated with worse recurrence-free survival (77.1% vs 95.5%, P = .02), whereas overall survival was similar between patients (P = .94). When controlling for demographics, tumor stage, pathologic risk criteria, and adjuvant therapy, NLR > 2.2 remained a significant independent predictor of recurrence on multivariate Cox regression analysis (HR 20.6, 95% CI 1.92-80.7, P = .012).
Conclusion:
While OS was similar across groups, a preoperative NLR of >2.2 predicted worse recurrence-free survival in a cohort of patients with HPV + OPSCC who underwent TORS. Future studies may consider integrating NLR into prospective trials as a complementary risk-stratification biomarker.