Prognostic significance of systemic inflammatory markers in oropharyngeal squamous cell carcinoma

Incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising and is increasingly associated with human papillomavirus (HPV) infection, which makes up approximately 50% of OPSCC cases in the UK. Patients presenting with HPV-positive OPSCC have better overall survival (OS) and prognosis. A significant proportion of these still have poor survival outcomes and identification of these patients remains a challenge. This study aims to investigate the predictive value of albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SIII) for overall survival in OPSCC. Seven hundred and twenty-eight patients were extracted from the West of Scotland Cancer Network database and met inclusion criteria with available blood markers at diagnosis. ROC curve analysis was constructed with respect to age, albumin and systemic inflammatory markers to determine diagnostic cut-offs, which were used to stratify subsequent Kaplan-Meier analyses. Univariate and multivariate analysis was carried out with respect to all baseline characteristics. Patients with lowered albumin, LMR and raised NLR, PLR and SIII presented with poorer OS over time as well as median survival times. HPV-negative patients presented with significantly poorer survival outcomes as compared to HPV-positive. Only albumin ≥35.5g/L (HR=0.683, 95%CI 0.538-0.868) and NLR≥4.0 (HR=1.416, 95%CI 1.031-1.946) were found to be independent prognostic factors in patients with OPSCC. Serum albumin and NLR represent valuable predictors of survival in OPSCC regardless of HPV status. A universal, diagnostic NLR cut-off remains unknown. Systemic inflammatory markers may be a helpful adjunct when assessing patients during MDT. • Incidence of HPV-positive oropharyngeal cancer in Scotland is increasing • Pre-treatment NLR≥4.0 and albumin<35.5g/L are independent survival predictors • NLR was independent of age, disease stage, HPV status and smoking history • Albumin<35.5g/L was an independent survival predictor in curative patients • Universal NLR cut-off remains unknown