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. 2025 May 6:15:1557652.
doi: 10.3389/fonc.2025.1557652. eCollection 2025.

Neutrophil/lymphocyte ratio: a potential biomarker in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors

Marianna Caterino #  1 , Giorgio Lo Giudice #  2 , Vincenzo Damiano  3 , Francesco Perri  4 , Guido Giordano  5 , Davide Ciardiello  6 , Aurora Mirabile  7 , Mario Pirozzi  8 , Andrea Pietro Sponghini  8 , Vincenzo Ricci  9 , Liliana Montella  10 , Raffaele Addeo  11 , Francesca Vignani  12 , Vincenzo Famiglietti  13 , Stefano Farese  13 , Sara Di Lorenzo  13 , Fortunato Ciardiello  13 , Morena Fasano  13
Affiliations

Neutrophil/lymphocyte ratio: a potential biomarker in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors

Marianna Caterino et al. Front Oncol. .

Abstract

Introduction: Literature has shown that there is a correlation between increased circulatory inflammatory factors and negative prognosis, which can be evaluated through the using the neutrophil and lymphocyte ratio (NLR). The aim of this research is to investigate the predictive and prognostic role of the NLR in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients, treated with immunotherapy, and its correlation to the overall survival (OS), progression free survival (PFS) and objective response rate (ORR).

Methods: This multicentric study coordinated by the Oncology Unit of University of Campania "Luigi Vanvitelli", retrospectively analyzed data from 135 patients diagnosed with R/M HNSCC from 13 Italian oncological centers.

Results: Two groups were made using the median NLR value of 4.2. 71 patients (52.6%) had NLR>4 and 64 patients (47.4%) had NLR<=4. Mean OS of patients with NLR>4 was significantly shorter than that of patients with NLR<=4 (23.1 vs 37.4 months, p= 0.002). Univariable analysis showed a statistically significant correlation between OS and NLR value (p=0.002), and between OS and ECOG (p=0.022). Median PFS stratified by NLR value, was statistically significant: 6.5 vs 20 months in patients with NLR>4 and NLR<=4, respectively (p= 0.013O). ORR in the general population was 32.6%. NLR-stratified ORR confirmed the unfavorable prognostic role of high NLR: 20% if NLR<=4, and 12.5% if NLR>4.

Discussion: Basal NLR value lower than the cut-off of 4 is independently associated with better OS, PFS and ORR in patients with R/M HNSCC treated with immunotherapy, in first- or second- line.

Keywords: HNSCC; ICI; NLR; immunotherapy; immunotherapy biomarkers.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Kaplan-Meier curves depicting overall survival (OS) (A) for the entire patient population and (B) stratified by neutrophil-to-lymphocyte ratio (NLR) groups (NLR ≤4 and NLR >4).
Figure 2
Figure 2
Kaplan-Meier curves illustrating progression-free survival (PFS) (A) for the entire patient population and (B) stratified by neutrophil-to-lymphocyte ratio (NLR) groups (NLR ≤4 and NLR >4).
See this image and copyright information in PMC

References

    1. Linee Guida Associazione Italiana di Oncologia Medica (AIOM). Available online at: https://www.aiom.it/linee-guida-aiom/ (Accessed July 8, 2024).
    1. Fasano M, D’Onofrio I, Belfiore MP, Angrisani A, Caliendo V, Della Corte CM, et al. . Head and neck squamous cell carcinoma in elderly patients: role of radiotherapy and chemotherapy. Cancers (Basel). (2022) 14:472. doi: 10.3390/cancers14030472 - DOI - PMC - PubMed
    1. Addeo R, Pompella L, Vitale P, Fattoruso SIS, Di Giovanni I, Perri F, et al. . The art of counseling in the treatment of head and neck cancer: exploratory investigation among perceptions of health professionals in southern Italy. Curr Oncol. (2022) 29:6277–86. doi: 10.3390/curroncol29090493 - DOI - PMC - PubMed
    1. Belfiore MP, Nardone V, D’Onofrio I, Pirozzi M, Sandomenico F, Farese S, et al. . Recurrent versus metastatic head and neck cancer: an evolving landscape and the role of immunotherapy. Biomedicines. (2024) 12:2080. doi: 10.3390/biomedicines12092080 - DOI - PMC - PubMed
    1. Menditti D, Santagata M, Imola G, Stagliano S, Vitagliano R, Boschetti CE, et al. . Personalized medicine in oral oncology: imaging methods and biological markers to support diagnosis of oral squamous cell carcinoma (OSCC): A narrative literature review. J Pers Med. (2023) 13:1397. doi: 10.3390/jpm13091397 - DOI - PMC - PubMed

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