An Investigation into the Delta Neutrophil-to-Lymphocyte Ratio as Prognostic Markers in Head and Neck Cancer Josue
1 Minaya ,
Andrew
1Donald
Results
Dr. Tristan
2 Tham
Conclusions
Sensitivity
Overall survival could not be predicted by the NLR, LMR, or PLR as all variables were not statistically significant. However, Event free survival showed that binary LMR, delta LMR, and delta NLR may be statistically significant. Upon Multivariable analysis, delta LMR was the only variable shown to have statistical significance on predicting event-free survival. Additionally, the results show that a delta LMR less than -1.48 corresponds to increased event-free survival. The mechanism of a patient’s LMR influencing event free survival is not understood.
Future Direction Future studies may benefit from expanding the duration of the study to gain more accurate data on patients who have had deaths posttreatment. Additionally, an expanded sample size would ensure more predictive results.
Methods
Specificity
Figure 1.1: ROC curve depicting sensitivity and specificity of Delta LMR data
Resources Survival Probability (%)
Patients with HNSCC (head and neck squamous cell carcinoma) affiliated with Northwell Health had their medical records combed for data, such as lab values, on both Allscripts and Sunrise. Among the data collected, pretreatment and posttreatment values for neutrophil (count and percentage), lymphocytes (count and percentage), and monocyte (count and percentage) were collected. Additionally, data on survival and recurrences were also collected. Ninety-three patients met criteria and were included in the study. A receiver operating characteristic (ROC) curve was constructed to determine the cutoff for lab values. Then, the area under the ROC curve (AUC) was included to assess the predictability of the model. AUC values range from 0.0 which denotes a nonpredictive model to 1.0 which denotes a predictive model. Then a Kaplan Meier curve was constructed to estimate survival endpoints. If a lab variable was significant on univariable analysis, it was selected for multivariable analysis. The alpha value was set to 0.05, and all analyses were preformed using MedCald for Windows, version 15.0.
Arif
1 Mahmud ,
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Lenox Hill Hospital
Background Head and neck cancers (HNC) are some of the most common cancers worldwide, estimated to have more than 880,000 new cases in the 2018 alone, resulting in more than 450,000 deaths. [1] Cancers of this variety are considered to occur in the larynx, oral cavity, oropharynx, nasopharynx, nasal cavity, paranasal sinuses, hypopharynx, and salivary glands. Treatment of HNC is dependent on various characteristics including the TNM (based on tumor size, lymph node involvement, and metastasis) staging of the tumor, the anatomical site of the tumor, the histological type, as well as the associated risk factors. Easily obtainable blood inflammatory biomarkers have shown some evidence in being able to predict the prognosis of head and neck cancers. [2,3,4] The objective of this study is to determine the prognostic value of these pretreatment biomarkers, posttreatment biomarkers, and the change (delta) of these biomarkers.
1 Ko ,
Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
Time (days) Figure 1.2: Kaplan Meier curve depicting patient survival over time against Delta LMR
1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020 Jul;70(4):313]. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492 2. Takenaka Y, Oya R, Kitamiura T, et al. Prognostic role of neutrophil-tolymphocyte ratio in head and neck cancer: A meta-analysis. Head Neck. 2018;40(3):647-655. doi:10.1002/hed.24986 3. Tham T, Olson C, Khaymovich J, Herman SW, Costantino PD. The lymphocyte-to-monocyte ratio as a prognostic indicator in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2018;275(7):1663-1670. doi:10.1007/s00405-018-4972-x 4. Bardash Y, Olson C, Herman W, Khaymovich J, Costantino P, Tham T. Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis. Oncol Res Treat. 2019;42(12):665-677. doi:10.1159/000502750