부산대학교 도서관

Background. Multiple studies link carcinogenesis and inflammation in both ways. On one hand, chronic inflammation promotes tumor development, and on the other hand, most tumors show an infiltrate of cells related to the inflammatory response that stimulate tumor progression. Moreover, the failure of the immune system to control and eradicate tumor cells could be partly responsible for the tumor progression. The degree of systemic inflammation correlates with the oncologic outcome in some tumor models. Studies carried out in different solid tumors have associated a decrease in disease control and survival with the increase of the circulating counts of neutrophils and monocytes, the decrease of lymphocytes, and an elevated ratio between neutrophils and lymphocytes (NLR). Objectives. The objective of the present study is to assess the prognostic capacity of the pre-treatment count of neutrophils, monocytes, lymphocytes and NLR in peripheral blood in a large series of patients with squamous cell carcinomas of the head and neck (HNSCC) treated consecutively in a single institution. In addition, the cohort of patients with oropharyngeal tumors was analyzed separately according to the status of the Human Papillomavirus (HPV). Materials and Methods. The clinical data used in this study were obtained retrospectively from a database that prospectively collects epidemiological, treatment and follow-up data of patients with HNSCC treated in our institution from 1985. We included 824 patients with an anatomopathological result of squamous cell carcinoma of the oral cavity, oropharynx, larynx or hypopharynx diagnosed in our center between January 2000 and December 2012 with a minimum follow-up of 2 years. We only included patients for whom we obtained the hematological parameters within 4 weeks prior to the start of treatment. The disease-specific survival and the local, regional and distant disease-free survival were analyzed according to the count of neutrophils, monocytes, lymphocytes and NLR. Results. We observed an ordered decrease in disease-specific survival as the quartile category of neutrophils, monocytes, and NLR increased. In the case of lymphocytes, only patients in the lowest quartile showed a poorer disease-specific survival. Considering the disease-specific survival as the dependent variable, a recursive partitioning analysis (RPA) classified the patients according to the neutrophil and monocyte counts. The 5-year disease-specific survival for the first node (Neutrophils <4.80x109/L - Monocytes <0.52x109/L) was 83.9%, for the second node (Neutrophils <4.80x109/L – Monocytes >0.52x109/L) it was 73.1%, for the third node (Neutrophils between 4.80-7.99x109/L) it was 61.4%, and for the fourth node (Neutrophils >7.99x109/L) it was 47.4%. When analyzing patients with oropharyngeal tumors according to HPV status, patients with HPV positive tumors had significantly lower neutrophil and monocyte counts and NLR than patients with HPV negative tumors. No differences in lymphocyte counts were found. Conclusions. A high pre-treatment count of neutrophils and monocytes and an elevated NLR, analyzed in peripheral blood, were independently associated with a worse prognosis in patients with HNSCC when analyzing the disease-specific survival and the local, regional and distant disease-free survival. The lymphocytes did not show prognostic capacity. We considered that the prognostic capacity of the NLR, basically depended on the neutrophil count. A classification of the patients according to neutrophil and monocyte counts could be considered a useful biomarker of survival in patients with HNSCC.