Background: Inflammation is involved in the progression of oral squamous cell carcinoma. We therefore postulate that a blood-based inflammatory marker, the neutrophil-to-lymphocyte ratio, could help to predict the prognosis in patients with oral squamous cell carcinoma receiving chemo-radiotherapy, and build a prognostic nomogram.
Methods: In 111 cases of oral squamous cell carcinoma, several baseline variables, including inflammatory markers and lactate dehydrogenase, were measured within the week of chemo-radiotherapy initiation as predictors of mortality and separate risk scores were developed.
Results: Dichotomized neutrophil-to-lymphocyte ratio was found to be associated with AJCC stage (p < 0.001). Patients with oral squamous cell carcinoma with a low neutrophil-to-lymphocyte ratio survived longer than those with a high neutrophil-to-lymphocyte ratio (overall survival HR=2.39, 95% CI 1.24– 4.61, p =0.009). The Harrell’s concordance (C )-statistic of the nomogram was 0.74 and the calibration curve demonstrated the goodness of fit.
Conclusion: The inflammatory marker neutrophil-to-lymphocyte ratio, obtained before chemo-radiotherapy, was an independent factor of survival prediction for oral squamous cell carcinoma. The nomogram incorporating immunological markers could more accurately predict individualized survival probability than the existing models. These findings are significant for the creation of personalized treatment strategies in the clinical setting.
Keywords: nomogram, oral squamous cell carcinoma, LDH, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio