Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy.
Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
ORL J Otorhinolaryngol Relat Spec. 2024;86(1):32-40. doi: 10.1159/000534079. Epub 2023 Nov 16.
The presence of cervical lymph node metastases is an unfavorable prognostic factor in head and neck squamous cell carcinoma (HNSCC) and a potential cause of treatment failure. Occult lymph node metastasis occurs in approximately 15-20% of HNSCC patients with a clinically negative neck (cN0), greatly impacting on their prognosis. The present study aimed to investigate the role of pre-treatment peripheral blood markers in predicting clinically occult cervical lymph node metastasis.
This multicenter, retrospective study was performed in a cohort of 472 patients diagnosed with cN0 HNSCC who underwent up-front surgery. Baseline neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory marker (SIM), and systemic immune-inflammation index (SII) were calculated from available blood parameters.
Oro-hypopharyngeal and oral cancers, locally advanced stage, moderately (G2), and poorly (G3) differentiated grade were associated with an increased risk of pathological lymph node involvement. NLR, LMR, PLR, SIM, and SII were significantly associated at multivariable analysis. NLR >2.12 was the most reliable at predicting occult lymph node metastasis (OR = 5.22; 95% CI: 2.14-12.75). We describe a predictive score integrating cancer site, local stage, and NLR which is effective at predicting positive lymph node pathological status.
The present study provides evidence that pre-treatment peripheral blood markers, in particular NLR, represent reliable predictors of clinically occult cervical lymph node metastasis in cN0 HNSCC. Therefore, the present study provides a novel useful predictive score for directing the elective management of the neck in patients with cN0 HNSCC.
在头颈部鳞状细胞癌（HNSCC）中，颈部淋巴结转移的存在是一个不利的预后因素，也是治疗失败的潜在原因。约 15-20%的临床颈阴性（cN0）HNSCC 患者存在隐匿性颈部淋巴结转移，这极大地影响了他们的预后。本研究旨在探讨治疗前外周血标志物在预测临床隐匿性颈部淋巴结转移中的作用。
本多中心回顾性研究纳入了 472 例接受初始手术的 cN0 HNSCC 患者。根据可用的血液参数计算了基线中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、全身炎症标志物（SIM）和全身免疫炎症指数（SII）。
口咽癌和口腔癌、局部晚期、中度（G2）和低分化（G3）与病理淋巴结受累风险增加相关。多变量分析显示，NLR、LMR、PLR、SIM 和 SII 均有显著相关性。NLR >2.12 是预测隐匿性淋巴结转移的最可靠指标（OR=5.22；95%CI：2.14-12.75）。本研究描述了一种整合癌症部位、局部分期和 NLR 的预测评分，该评分可有效预测阳性淋巴结的病理状态。
本研究表明，治疗前外周血标志物，尤其是 NLR，可作为 cN0 HNSCC 患者临床隐匿性颈部淋巴结转移的可靠预测指标。因此，本研究为指导 cN0 HNSCC 患者选择性颈部管理提供了一种新的有用预测评分。
