Prognostic Utility of Hematological Inflammatory Markers in Stratifying Cancer Risk in Laryngeal Premalignant Lesions

OBJECTIVE: To evaluate the prognostic utility of systemic inflammatory markers derived from complete blood count (neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio [MLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]) in predicting malignant transformation of laryngeal dysplasia, compared with conventional histological grading. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral university hospital. METHODS: A retrospective analysis was conducted on 146 patients diagnosed with histologically confirmed laryngeal dysplasia between 2009 and 2019, who had a preoperative complete blood count (CBC) performed within 30 days before diagnosis. The primary endpoint was the development of invasive carcinoma at the index site, confirmed by histopathology. Transformation-free survival was analyzed using Kaplan-Meier curves and Cox proportional hazards models to estimate adjusted hazard ratios (HRs). Model discrimination was assessed with AUC/c-index, and time-dependent ROC analyses were performed. RESULTS: During a median follow-up of 85.4 months, 45 of 146 patients (30.8%) developed invasive carcinoma. On multivariable Cox analysis, higher NLR was independently associated with an increased risk of malignant transformation (HR = 3.80; 95% CI 1.56-9.26; P = .003), whereas histological grade showed no significant association (P = .89). Daily alcohol intake correlated positively with NLR and MLR values. CONCLUSIONS: Preoperative NLR is an independent prognostic marker for malignant transformation in laryngeal dysplasia, providing incremental prognostic value beyond histological grade. Prospective validation using time-to-event modeling and prespecified cut-off points is warranted.