Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictive biomarkers for treatment response in primary advanced hypopharyngeal squamous cell carcinoma treated with chemoimmunotherapy

To evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in peripheral blood for assessing the treatment response to chemoimmunotherapy in primary advanced hypopharyngeal squamous cell carcinoma (HPSCC), we retrospectively reviewed the medical records of patients treated with neoadjuvant taxane-platinum (TP) chemotherapy plus an anti-programmed cell death-1 (PD-1) inhibitor at Wuhan Union Hospital from Jan 2020 to Dec 2022. We collected data on absolute neutrophil, lymphocyte, and platelet counts from routine blood tested at baseline and within a week after the first treatment. A total of 35 patients were included in this study. Post-treatment NLR (r_s = - 0.445, p = 0.007) and PLR (r_s = - 0.475, p = 0.004) demonstrated negative correlations with treatment response assessed by the Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). NLR and PLR were significantly lower in patients achieving a complete response than those not achieving it (with p values of 0.04 and 0.02 for NLR and PLR, respectively). Among the 27 patients who underwent radical surgery following three cycles of chemoimmunotherapy, a high PLR after the first treatment was negatively correlated with attaining a pathological complete response (pCR) (r_s = - 0.424, p = 0.028). For predicting pCR, the receiver operating characteristic (ROC) curve of PLR after the first treatment yielded an area under the curve (AUC) of 0.759 (95% confidence interval [CI]: 0.572-0.946, p = 0.031), with a sensitivity of 77.8% and a specificity of 72.2%. This research underscores the predictive value of the NLR and PLR in appraising not only the treatment response, as gauged by the RECIST 1.1, but also the pathological response to chemoimmunotherapy in patients with HPSCC.