Neutrophil-to-Lymphocyte Ratio in Laryngeal SQCC Treated by Radiotherapy: Prognostic and Predictive Value

Area of Science:

• Oncology
• Radiation Oncology
• Cancer Biomarkers

Background:

• Laryngeal squamous cell carcinoma (SQCC) is often treated with radiotherapy or chemoradiotherapy.
• The neutrophil-to-lymphocyte ratio (NLR) is a potential prognostic marker in head and neck SQCC.
• Lymphocytes are radiosensitive, potentially causing fluctuations in NLR during and after radiotherapy.

Purpose of the Study:

• To evaluate dynamic changes in NLR, absolute lymphocyte count (ALC), and absolute neutrophil count (ANC) during and after radiotherapy for laryngeal SQCC.
• To assess the association between these hematologic parameters and oncologic outcomes.

Main Methods:

• Retrospective review of 174 patients with laryngeal SQCC treated with definitive-intent radiotherapy or chemoradiotherapy (2015-2021).
• NLR, ANC, and ALC values were recorded at treatment initiation, completion, and 3-6 months post-treatment.
• Oncologic outcomes were analyzed in relation to hematologic parameters.

Main Results:

• Mean NLR significantly increased from treatment initiation to completion and decreased by 3-6 months post-treatment.
• An elevated NLR (>4) at treatment completion and 3-6 months post-treatment was associated with worse overall and disease-free survival.
• Mean ALC decreased significantly during treatment and partially recovered post-treatment, while ANC remained stable.

Conclusions:

• NLR significantly increases during radiotherapy for laryngeal cancer, primarily due to radiation-induced lymphocyte depletion.
• Elevated NLR levels at the end of treatment and during follow-up are novel predictors of poorer survival in laryngeal SQCC.
• Routine monitoring of NLR and ALC is supported for patients undergoing radiotherapy for laryngeal cancer.