Prognostic Value of Inflammatory Markers in Nasopharyngeal Carcinoma Patients in the Intensity-Modulated Radiotherapy Era

Abstract

Purpose

Inflammatory markers have been widely used in various cancers, but rarely in nasopharyngeal carcinoma (NPC). Here, we evaluated the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), systemic immune index (SII), and systemic inflammation response index (SIRI) on NPC in the intensity-modulated radiotherapy (IMRT) era.

Methods

We retrospectively analyzed data from NPC patients from the Renmin Hospital of Wuhan University, between January 2012 and July 2020. We used Chi-square test or Fisher’s exact test to compare the baseline characteristics, then applied Kaplan–Meier (K-M) survival analysis to compare the overall survival (OS) and progression-free survival (PFS) rates. Multivariate Cox proportional risk models were applied to identify independent prognostic factors.

Results

We enrolled a total of 342 NPC patients and found optimal cut-off values of 2.65, 184.91, 804.08, and 1.34 for NLR, PLR, SII, and SIRI, respectively. K-M survival analysis revealed that high NLR, PLR, SII, and SIRI were significantly associated with worse OS and PFS relative to those in the low groups. Results from univariate Cox analysis showed that clinical, T, and M stages, as well as NLR, PLR, SII, and SIRI were associated with OS, whereas age, alongside the aforementioned parameters, was associated with PFS. Moreover, multivariate Cox analysis showed that age ≥49 years (HR=2.48, 95% CI=1.21–5.05, P=0.013) and M1 stage (HR=3.84, 95% CI=1.52–9.73, P=0.013) were independent prognostic factors for OS, whereas SIRI ≥1.34 (HR=1.91, 95% CI=1.05–3.47, P=0.034) and M1 stage (HR=2.91, 95% CI=1.44–5.86, P=0.003) were independent prognostic factors for PFS.

Conclusion

Overall, our findings indicated that high NLR, PLR, SII, and SIRI were significantly associated with poor OS and PFS in NPC patients. High SIRI may be an independent risk factor for PFS of NPC patients in the IMRT era.

Keywords:

• nasopharyngeal carcinoma
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• systemic immune inflammation index
• systemic inflammatory response index
• prognosis

Acknowledgments

This work was supported by the National Natural Science Foundation of China (81670144).

Data Sharing Statement

All datasets supporting the conclusions of this article are available from the authors upon request.

Ethical Approval

This study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.

Consent to Participate

Written informed consent was waived by our ethics committee because of the retrospective nature of the study. However, the study was conducted in accordance with the ethical standards of the Helsinki Declaration. All patient data accessed complied with adherence to the rules of data protection and privacy regulations.

Consent for Publication

All authors read and approved the final version of the manuscript prior to submission for publication.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.