Prognostic Value of Neutrophil Percentage-to-Albumin Ratio in Patients with Oral Cavity Cancer

Abstract

This study investigated preoperative neutrophil percentage-to-albumin ratio (NPAR) for predicting oral cavity squamous cell carcinoma (OSCC) survival. We retrospectively analyzed 368 patients who received curative OSCC surgery between 2008 and 2017. Receiver operating characteristic curve analyses were employed to identify the optimal NPAR cutoff (16.93), and the patients were then separated into low-NPAR and high-NPAR groups. Intergroup differences in survival were determined through Kaplan−Meier analysis and log-rank tests. Disease-free survival (DFS) and overall survival (OS) predictors were identified using Cox proportional-hazards models. A nomogram integrating independent prognostic factors was proposed to increase the accuracy of OS prediction. A high NPAR (≥16.93) was associated with worse median OS and DFS than was a low NPAR (both p < 0.001); this finding was confirmed through multivariate analyses (hazard ratio (HR) for OS = 2.697, p < 0.001; and HR for DFS = 1.671, p = 0.008). The nomogram’s favorable predictive ability was confirmed by the calibration plots and concordance index (0.784). The preoperative NPAR is thus a promising prognostic biomarker in patients with OSCC after external validation in a larger cohort. Our nomogram can facilitate clinical use of the NPAR and provides accurate individualized OS predictions.

Keywords: biomarker; neutrophil percentage-to-albumin ratio; nomogram; oral cavity cancer; prognosis.

Figure 1

Neutrophil percentage-to-albumin ratio cutoff obtained through receiver operating characteristic curve analysis. Abbreviation: AUC, area under the curve.

Figure 2

(a) Overall survival and (b) disease-free survival Kaplan–Meier curves for patients with oral squamous cell carcinoma classified on the basis of preoperative NPAR. Prognosis was significantly poorer in patients with an NPAR of ≥16.93. Abbreviation: NPAR, neutrophil percentage-to-albumin ratio.

Figure 3

Kaplan–Meier survival curves for patients classified based on cutoff of NPAR and cancer stage. Superior overall survival was discovered in the low-NPAR group among patients with (a) stages I–II and (c) stages III–IV OSCC (both p < 0.001); a similar finding was obtained for disease-free survival for (b) stages I–II and (d) stages III–IV OSCC (p = 0.089 and 0.001, respectively). Abbreviation: NPAR, neutrophil percentage-to-albumin ratio.

Figure 4

(a) Nomogram predicting overall survival (OS) based on neutrophil percentage-to-albumin ratio and prognostic factors identified in multivariate analysis. The degree of risk contributed by each variable is indicated by the line segment and its uppermost points. The total number of points is the sum of each variable’s points. Drawing a vertical line from the calculated total number of points gives the likelihood of 3-year and 5-year OS. Calibration plots for (b) 3-year and (c) 5-year OS. The gray line at 45° reflects perfectly accurate prediction; the predictive outcomes of the nomogram are depicted by the blue line. The performance of the nomogram and the 95% confidence intervals for the OS predictions are shown as blue dots with bars, respectively. Abbreviations: CCI, Charlson comorbidity index; M–D, moderately differentiated; NPAR, neutrophil percentage-to-albumin ratio; P–D, poorly differentiated; PNI, perineural invasion; W–D, well differentiated.