Prognostic impact of neutrophil-lymphocyte ratio in head and neck cancer: a decade of evidence

Background: Every cancer patient undergoes a full blood count prior to initial treatment. The neutrophil-to-lymphocyte ratio (NLR), derived from this routine test, has been suggested as a potential prognostic marker in head and neck squamous cell carcinoma (HNSCC) based on evidence from smaller studies. This study aims to validate the prognostic value of NLR in a large, population-based cohort of HNSCC patients, accounting for human papillomavirus (HPV) status and treatment modalities. Methods: A retrospective cohort study was conducted at a single centre in Western Australia, including patients diagnosed with HNSCC between January 1, 2013, and December 31, 2023. NLR was calculated from pre-treatment full blood counts and correlated with post-treatment complications, overall survival (OS), disease-free survival, and recurrence. Results: The study included 927 patients. An NLR greater than 3 was significantly associated with increased complications [P<0.001, 95% confidence interval (CI): 19.63, 83.43], reduced OS (P<0.001), and higher recurrence rates (P<0.001). Differences in outcomes were observed across treatment modalities and subsites, with the oropharynx emerging as the most common site. Among oropharyngeal cancers, 77.5% were associated with HPV positivity. Conclusions: Elevated NLR is a significant prognostic marker in patients with HNSCC, correlating with poorer outcomes, including increased complications, recurrence, and reduced survival. This study supports the integration of NLR into pre-treatment assessments to improve risk stratification and guide treatment planning.