Prognostic Utility of Hematological Inflammatory Markers in Stratifying Cancer Risk in Laryngeal Premalignant Lesions.

Abstract

To evaluate the prognostic utility of systemic inflammatory markers derived from complete blood count (neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio [MLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]) in predicting malignant transformation of laryngeal dysplasia, compared with conventional histological grading. Retrospective cohort study. Tertiary referral university hospital. A retrospective analysis was conducted on 146 patients diagnosed with histologically confirmed laryngeal dysplasia between 2009 and 2019, who had a preoperative complete blood count (CBC) performed within 30 days before diagnosis. The primary endpoint was the development of invasive carcinoma at the index site, confirmed by histopathology. Transformation-free survival was analyzed using Kaplan-Meier curves and Cox proportional hazards models to estimate adjusted hazard ratios (HRs). Model discrimination was assessed with AUC/c-index, and time-dependent ROC analyses were performed. During a median follow-up of 85.4 months, 45 of 146 patients (30.8%) developed invasive carcinoma. On multivariable Cox analysis, higher NLR was independently associated with an increased risk of malignant transformation (HR = 3.80; 95% CI 1.56-9.26; P = .003), whereas histological grade showed no significant association (P = .89). Daily alcohol intake correlated positively with NLR and MLR values. Preoperative NLR is an independent prognostic marker for malignant transformation in laryngeal dysplasia, providing incremental prognostic value beyond histological grade. Prospective validation using time-to-event modeling and prespecified cut-off points is warranted.