Preoperative Neutrophil‐to‐Lymphocyte Ratio Predicts Recurrence in HPV‐Associated Oropharyngeal Cancer After Transoral Robotic Surgery
Micah K. Harris, Kelly Daniels, Vanessa Helou, Katie Carlson, Shivam D. Patel, Elizabeth Sell, Matthew E. Spector, Jose P. Zevallos, Joshua D. Smith, Jessica H. Maxwell, Seungwon Kim, Shaum S. Sridharan, Kevin J. ContreraAbstract
Objective
Evaluate the role of preoperative neutrophil‐to‐lymphocyte ratio (NLR) as a predictor of survival outcomes after transoral robotic surgery (TORS) for human papillomavirus‐related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC).
Study Design
Single‐institution retrospective review of patients who underwent TORS for HPV + OPSCC from April 2014 to October 2021 and had a preoperative complete blood count test.
Setting
Tertiary academic center.
Methods
Preoperative NLR was calculated from complete blood counts drawn within 1 month prior to surgery. Receiver operating characteristic curves evaluated performance of prognostic markers. Kaplan‐Meier estimator and Cox regression analyses were used to evaluate survival outcomes when controlling for confounding variables.
Results
A total of 117 patients were included (85.5% male, 94.0% Caucasian, 59.6 ± 9.1 years old), of which 13 patients (11.1%) recurred at a median of 23.5 ± 23 months, including 7 distant metastases. At the latest follow‐up, 90.6% remained alive. On Kaplan‐Meier analyses, a preoperative NLR of >2.2 was associated with worse recurrence‐free survival (77.1% vs 95.5%, P = .02), whereas overall survival was similar between patients ( P = .94). When controlling for demographics, tumor stage, pathologic risk criteria, and adjuvant therapy, NLR > 2.2 remained a significant independent predictor of recurrence on multivariate Cox regression analysis (HR 20.6, 95% CI 1.92‐80.7, P = .012).
Conclusion
While OS was similar across groups, a preoperative NLR of >2.2 predicted worse recurrence‐free survival in a cohort of patients with HPV + OPSCC who underwent TORS. Future studies may consider integrating NLR into prospective trials as a complementary risk‐stratification biomarker.