Role of Monocyte Count and Neutrophil-to- Lymphocyte Ratio in Survival of Oral Cancer Patients

Bobdey, Saurabh; Ganesh, Balasubramaniam; Mishra, Prabhashankar; Jain, Aanchal

doi:10.1055/s-0036-1587318

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International Archives of Otorhinolaryngology

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Sumário

Original Research • Int. Arch. Otorhinolaryngol. 21 (01) • Jan-Mar 2017 • https://doi.org/10.1055/s-0036-1587318 copy

Role of Monocyte Count and Neutrophil-to- Lymphocyte Ratio in Survival of Oral Cancer Patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Inflammation seems to play a critical role in the development and progression of numerous cancers. Peripheral blood leukocyte count is an easily assessable parameter of systemic inflammatory response.

Objective

The aim of this study was to investigate whether the pretreatment leukocyte counts can predict the prognosis of patients with oral cavity cancer.

Methods

Medical records of 471 oral cavity cancer patients diagnosed between January 2007 and December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards analyses were applied to evaluate the associations of leukocyte counts with overall survival.

Results

The overall five year's survival of the cohort was found to be 49.4%. On univariate analysis, elevated monocyte count (≥500/mm3) and neutrophil-to-lymphocyte ratio (NLR) (>2.38) were associated with poor overall survival (OS) (p = 0.001 and 0.000, respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and NLR levels were significant independent predictors of worse OS (HR = 1.385, 95% CI = 1.049 - 1.829; p < 0.05 and HR = 1.392, 95% CI = 1.045 - 1.855; p < 0.05, respectively). The advanced overall stage and lymph nodal involvement were also independent indicators for poor OS.

Conclusions

Higher pretreatment monocyte and NLR levels are independent predictors of poor prognosis for patients with oral cavity cancer. Thus, these easily accessed variables can serve as a potent marker to predict the outcomes of oral cancer patients.

Keywords:
oral cancer; prognosis; survival; monocyte; neutrophil-tolymphocyte ratio

Parameter	No. of patients	Percentage (%)
Age
mean	50 Years	--
Range	25–85 Years	--
Sex
Male	329	69.9
Female	142	30.1
T Classification
T1	41	8.7
T2	142	30.1
T3	56	11.9
T4	232	49.3
N Classification
N0	208	44.2
N+	263	55.8
M Classification
M0	469	99.6
M1	2	0.4
Tumor Stage, AJCC
I	32	6.8
II	92	19.5
III	76	16.1
IV	271	57.5

	Univariate		Multivariate
Parameter	HR(95% CI)	p	HR(95% CI)	p
Age, ≥65 years	1.088(0.745 - 1.589)	0.664	--	--
Sex, (male)	1.244(0.928 - 1.669)	0.145	--	--
TNM stage (III + IV)	3.155(2.168 - 4.591)	0.000**	1.921(1.19 3 - 3.092)	0.007**
Lymph node mets	2.492(1.876 - 3.310)	0.000**	1.715(1.200 - 2.451)	0.003**
Neutrophil ≥4.900 10⁹/L	1.290(0.989 - 1.683)	0.060	--	--
Lymphocyte ≤1.980 10⁹/L	1.224(0.941 - 1.592)	0.131	--	--
Monocyte ≥0.500 10⁹/L	1.558(1.190 - 2.040)	0.001**	1.385(1.049 - 1.829)	0.021**
WBC ≥7.900 10⁹/L	1.352(1.037 - 1.764)	0.026**		0.164
Neutrophil/ lymphocyte ratio (NLR), ≥2.38	1.676(1.271 - 2.209)	0.000**	1.392(1.045 - 1.855)	0.024**
Neutrophil/ lymphocyte ratio (NLR), ≥5	1.348(0.954 - 1.904)	0.091	--	--
Treatment (single/ multi-modality)	0.924(0.712–1.200)	0.555	--	--

Characteristic	NLR < 2.38(n= 199)	NLR ≥2.38(n= 272)	p	LM Count< 500 (10⁹/L)(n= 206)	HM Count≥ 500 (10⁹/L)(n= 265)	p
Mean age (years)	50.20 ± 12.01	51.84 ± 12.48	0.152	50.37 ± 11.53	51.75 ± 12.85	0.225
Tobacco, no. (%)
Non-chewers	82 (41.2)	120 (44.1)	0.528	92 (44.7)	110 (41.5)	0.493
Chewers	117 (58.8)	152 (55.9)	--	114 (55.3)	155 (58.5)	--
Non-smokers	144 (72.4)	212 (77.9)	0.164	153 (74.3)	203 (76.6)	0.559
Smokers	55 (27.6)	60 (22.1)	--	53 (25.7)	62 (23.4)	--
Alcohol, no. (%)
Non-drinker	156 (78.4)	229 (84.2)	0.108	171 (83.0)	214 (80.8)	0.530
Drinker	43 (21.6)	43 (15.8)	--	35 (17.0)	51 (19.2)	--
T-classification
T1–T2	105 (52.8)	78 (28.7)	0.000**	86 (47.0)	97 (53.0)	0.256
T3–T4	94 (47.2)	194 (71.3)	--	120 (58.3)	168 (63.4)	--
N-classification
N0	101 (50.8)	107 (39.5)	0.015**	99 (48.1)	109 (41.3)	0.143
N+	98 (49.2)	164 (60.5)	--	107 (51.9)	155 (58.7)	--
Overall stage
I–II	75 (37.7)	49 (18.0)	0.000**	63 (30.6)	61 (23.0)	0.064
III–IV	124 (62.3)	223 (82.0)	--	143 (69.4)	204 (77.0)	--
Treatment
Uni-modality	98 (49.2)	127 (46.7)	0.583	100 (48.5)	125 (47.2)	0.767
Dual/ Multi-modality	101 (50.8)	145 (53.3)	--	106 (51.5)	140 (52.8)	--
Hematological Parameters
Red blood cell, X10⁶ /lL	4.60 ± 0.64	4.57 ± 0.70	0.145	4.52 ± 0.69	4.53 ± 0.67	0.888
Hemoglobin, g/dL	12.8 ± 2.1	12.7 ± 2.2	0.528	12.7 ± 2.2	12.7 ± 2.2	0.987
Hematocrit, %	38.6 ± 5.9	38.2 ± 6.4	0.464	38.3 ± 6.2	38.4 ± 6.2	0.884
MCV, fL	84.4 ± 10.0	85.8 ± 9.6	0.144	85.1 ± 9.3	85.2 ± 10.1	0.925
MCH, pg/cell	28.0 ± 3.8	28.5 ± 3.7	0.165	28.3 ± 3.7	28.3 ± 3.9	0.994
MCHC, g/dL	33.1 ± 1.3	33.2 ± 1.3	0.688	33.2 ± 1.3	33.1 ± 1.3	0.640

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[1] Address for correspondence Saurabh Bobdey, MD, DNB, Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai 400012, India (e-mail: sbobdey@yahoo.com).