Original Article
Pretreatment neutrophil-to-lymphocyte ratio as predictor of survival for patients with metastatic nasopharyngeal carcinoma
Ying Jin MD,
Xiao Ye MD,
Chunxiao He MD,
Beibei Zhang MD,
Yiping Zhang MD,
Ying Jin MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorXiao Ye MD
Department of Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou, China
Search for more papers by this authorChunxiao He MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorBeibei Zhang MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorCorresponding Author
Yiping Zhang MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Corresponding author: Y. Zhang, Department of Medical Oncology, Zhejiang Cancer Hospital, 38 Guang Ji Road, Hangzhou, 310022, China. E-mail: [email protected]Search for more papers by this authorYing Jin MD,
Xiao Ye MD,
Chunxiao He MD,
Beibei Zhang MD,
Yiping Zhang MD,
Ying Jin MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorXiao Ye MD
Department of Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou, China
Search for more papers by this authorChunxiao He MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorBeibei Zhang MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Search for more papers by this authorCorresponding Author
Yiping Zhang MD
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
Corresponding author: Y. Zhang, Department of Medical Oncology, Zhejiang Cancer Hospital, 38 Guang Ji Road, Hangzhou, 310022, China. E-mail: [email protected]Search for more papers by this authorABSTRACT
Background
The outcomes of patients with metastatic nasopharyngeal carcinoma (NPC) differ between individuals. The purpose of this study was to examine the impact of neutrophil-to-lymphocyte ratio (NLR) on survival in patients with metastatic NPC.
Methods
A total of 229 patients with disseminated NPC were evaluated. The effects of pretreatment peripheral blood neutrophil, lymphocyte, and NLR on survival were examined using the proportional hazards regression model to estimate hazard ratio (HR). The relationship between short-term treatment efficacy and pretreatment NLR was analyzed using the chi-square test.
Results
The pretreatment elevated neutrophil count (p = .020), percentage of neutrophil (p < .001), and NLR (p = .002) were statistically significantly associated with a poor prognosis. The cutoff value selected for NLR was 3.6. The median survival time was 15.3 months for the high-NLR group and was 23.5 months for the low-NLR group (p < .001).
Conclusion
NLR is a prognosticator in patients with metastatic NPC. © 2014 Wiley Periodicals, Inc. Head Neck 37: 69–75, 2015
REFERENCES
- 1Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 2006; 15: 1765–1777.
- 2Shanmugaratnam K, Chan SH, de-Thé G, et al. Histopathology of nasopharyngeal carcinoma: correlations with epidemiology, survival rates and other biological characteristics. Cancer 1979; 44: 1029–1044.
10.1002/1097-0142(197909)44:3<1029::AID-CNCR2820440335>3.0.CO;2-5 CAS PubMed Web of Science® Google Scholar
- 3Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma. Semin Cancer Biol 2002; 12: 421–429.
- 4Chiesa F, De Paoli F. Distant metastases from nasopharyngeal cancer. ORL J Otorhinolaryngol Relat Spec 2001; 63: 214–216.
- 5Liu MT, Hsieh CY, Chang TH, Lin JP, Huang CC, Wang AY. Prognostic factors affecting the outcome of nasopharyngeal carcinoma. Jpn J Clin Oncol 2003; 33: 501–508.
- 6Gunn GB, Villa RD, Sedler RR, Hardwicke F, Fornari GA, Mark RJ. Nasopharyngeal carcinoma metastasis to the pituitary gland: a case report and literature review. J Neurooncol 2004; 68: 87–90.
- 7Tao Y, Bidault F, Bosq J, Bourhis J. Distant metastasis of undifferentiated carcinoma of nasopharyngeal type. Onkologie 2008; 31: 574–575.
- 8Bensouda Y, Kaikani W, Ahbeddou N, et al. Treatment for metastatic nasopharyngeal carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128: 79–85.
- 9Razak AR, Siu LL, Liu FF, Ito E, O'Sullivan B, Chan K. Nasopharyngeal carcinoma: the next challenges. Eur J Cancer 2010; 46: 1967–1978.
- 10Fandi A, Bachouchi M, Azli N, et al. Long-term disease-free survivors in metastatic undifferentiated carcinoma of nasopharyngeal type. J Clin Oncol 2000; 18: 1324–1330.
- 11Hui EP, Leung SF, Au JS, et al. Lung metastasis alone in nasopharyngeal carcinoma: a relatively favorable prognostic group. A study by the Hong Kong Nasopharyngeal Carcinoma Study Group. Cancer 2004; 101: 300–306.
- 12Jin Y, Cai XY, Cai YC, et al. To build a prognostic score model containing indispensible tumour markers for metastatic nasopharyngeal carcinoma in an epidemic area. Eur J Cancer 2012; 48: 882–888.
- 13Ong YK, Heng DM, Chung B, et al. Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer 2003; 39: 1535–1541.
- 14Teo PM, Kwan WH, Lee WY, Leung SF, Johnson PJ. Prognosticators determining survival subsequent to distant metastasis from nasopharyngeal carcinoma. Cancer 1996; 77: 2423–2431.
10.1002/(SICI)1097-0142(19960615)77:12<2423::AID-CNCR2>3.0.CO;2-N CAS PubMed Web of Science® Google Scholar
- 15Balkwill F, Mantovani A. Cancer and inflammation: implications for pharmacology and therapeutics. Clin Pharmacol Ther 2010; 87: 401–406.
- 16Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature 2008; 454: 436–444.
- 17Donskov F, von der Maase H. Impact of immune parameters on long-term survival in metastatic renal cell carcinoma. J Clin Oncol 2006; 24: 1997–2005.
- 18Teramukai S, Kitano T, Kishida Y, et al. Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer 2009; 45: 1950–1958.
- 19Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012; 19: 217–224.
- 20Cedrés S, Torrejon D, Martínez A, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012; 14: 864–869.
- 21Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009; 58: 15–23.
- 22Hung HY, Chen JS, Yeh CY, et al. Effect of preoperative neutrophil-lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis 2011; 26: 1059–1065.
- 23Jung MR, Park YK, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol 2011; 104: 504–510.
- 24An X, Ding PR, Wang FH, Jiang WQ, Li YH. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in nasopharyngeal carcinoma. Tumour Biol 2011; 32: 317–324.
- 25He JR, Shen GP, Ren ZF, et al. Pretreatment levels of peripheral neutrophils and lymphocytes as independent prognostic factors in patients with nasopharyngeal carcinoma. Head Neck 2012; 34: 1769–1776.
- 26Ferrigno D, Buccheri G. Hematologic counts and clinical correlates in 1201 newly diagnosed lung cancer patients. Monaldi Arch Chest Dis 2003; 59: 193–198.
- 27Paesmans M, Sculier JP, Lecomte J, et al. Prognostic factors for patients with small cell lung carcinoma: analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years. Cancer 2000; 89: 523–533.
- 28Schmidt H, Suciu S, Punt CJ, et al. Pretreatment levels of peripheral neutrophils and leukocytes as independent predictors of overall survival in patients with American Joint Committee on Cancer Stage IV Melanoma: results of the EORTC 18951 Biochemotherapy Trial. J Clin Oncol 2007; 25: 1562–1569.
- 29Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005; 91: 181–184.
- 30DeNardo DG, Johansson M, Coussens LM. Immune cells as mediators of solid tumor metastasis. Cancer Metastasis Rev 2008; 27: 11–18.
- 31Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther 2012; 87: 504–508.
- 32Kusumanto YH, Dam WA, Hospers GA, Meijer C, Mulder NH. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis 2003; 6: 283–287.
- 33Fridlender ZG, Sun J, Kim S, et al. Polarization of tumor-associated neutrophil phenotype by TGF-beta: “N1” versus “N2” TAN. Cancer Cell 2009; 16: 183–194.
- 34Ji H, Houghton AM, Mariani TJ, et al. K-ras activation generates an inflammatory response in lung tumors. Oncogene 2006; 25: 2105–2112.
- 35McLoughlin RM, Witowski J, Robson RL, et al. Interplay between IFN-gamma and IL-6 signaling governs neutrophil trafficking and apoptosis during acute inflammation. J Clin Invest 2003; 112: 598–607.
- 36Nozawa H, Chiu C, Hanahan D. Infiltrating neutrophils mediate the initial angiogenic switch in a mouse model of multistage carcinogenesis. Proc Natl Acad Sci U S A 2006; 103: 12493–12498.
- 37Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009; 58: 15–23.
- 38Wee JL, Greenwood DL, Han X, Scheerlinck JP. Inflammatory cytokines IL-6 and TNF-α regulate lymphocyte trafficking through the local lymph node. Vet Immunol Immunopathol 2011; 144: 95–103.
- 39Dworacki G, Meidenbauer N, Kuss I, et al. Decreased zeta chain expression and apoptosis in CD3+ peripheral blood T lymphocytes of patients with melanoma. Clin Cancer Res 2001; 7(3 Suppl): 947s–957s.
- 40Shau HY, Kim A. Suppression of lymphokine-activated killer induction by neutrophils. J Immunol 1988; 141: 4395–4402.
Citing Literature
