Pretreatment Neutrophil-to-Lymphocyte Ratio (NLR) Predicts Treatment Toxicity and Intolerance in Operable Head and Neck Cancer: An Ambispective Cohort Study.

Abstract

Pretreatment neutrophil to lymphocyte ratio (NLR) is a negative prognostic marker for survival in head and neck cancer (HNC). Its association with treatment toxicity and intolerance in patients undergoing curative-intent surgery is unknown. Ambispective study of patients with operable stage II-IV, HPV-negative HNC treated at two academic hospitals. Multiple logistic regression was performed to evaluate the association between pretreatment NLR and short-term treatment outcomes including treatment toxicity and intolerance. Among 456 patients, 194 experienced treatment-related toxicity, defined as grade ≥ 3 adverse events, and 200 exhibited treatment intolerance, defined as treatment discontinuation or delay due to poor tolerance. High pretreatment NLR was significantly associated with an increased risk of toxicity (OR 1.04; 95% CI: 1.00-1.09) and intolerance (OR 1.06; 95% CI: 1.01-1.12). Patients with an NLR < 2.5 had significantly lower odds of experiencing toxicity (OR 0.50; 95% CI: 0.26-0.96) and intolerance (OR 0.57; 95% CI: 0.33-0.99) after adjusting for multiple confounders. Low pretreatment NLR was associated with reduced treatment toxicity and lower rates of intolerance in patients undergoing curative-intent surgery for HNC.