The prognostic value of neutrophil-to-lymphocyte ratio in nasopharyngeal cancer

Kandaz M., Balsak A., Yaldız Çobanoğlu H. B.

Northwestern Medical Journal, vol.5, no.1, pp.16-24, 2025 (Peer-Reviewed Journal)

  • Publication Type: Article / Article
  • Volume: 5 Issue: 1
  • Publication Date: 2025
  • Doi Number: 10.54307/nwmj.2025.77
  • Journal Name: Northwestern Medical Journal
  • Journal Indexes: TR DİZİN (ULAKBİM)
  • Page Numbers: pp.16-24
  • Karadeniz Technical University Affiliated: Yes

Abstract

Introduction: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) for nasopharyngeal carcinoma (NPC) continues to be debated. This study was conducted to enhance the accuracy of its prognostic value through a single-centre analysis.

Methods: Ninety-seven patients with NPC who received adjuvant radiotherapy between 1998 and 2022 were analyzed retrospectively.

Results: The study included a total of 97 patients who were treated for NPC and had available data. In 54 (56%) patients the NLR was ≤3 and in 43 (44%) the NLR was >3. The mean age of the patients was 49.64±14.51 (range: 12-82) years. Four patients were ≤18 years old and 93 patients were >19 years old. Sixty-three (65%) patients were male, 34 (35%) patients were female. For stage I patients, NLR was ≤3 in 2 (2%) and >3 in 2 (2%) patients. For stage II patients, NLR was ≤3 in 10 (11%) and >3 in 8 (8%) patients. For stage III patients, NLR was ≤3 in 29 (30%) and >3 in 25 (26%) patients. For stage IVA patients, NLR was ≤3 in 12 (12%) and >3 in 8 (8%) patients. For stage IVB patients, NLR was >3 in 1 (1%). The follow-up period was 79.4±72.1 (2-279) months. In all patients, mean overall survival (OS) was 159.37±13.66 (132.97-185.76) months, median 205±31.11 (144-265.99) months, The 1-, 2- , 3- and 5-year survival rates were 87.3%, 81.5%, 74.3%, and 65.3%, respectively. In general, 54 (56%) of the patients had NLR ≤3, while 43 (44%) had NLR >3. Mean survival times were 169.72±14.2 (95%CI 141.86-197.56) and 133.88±18.95 (95%CI 96.72-171.03) months for NLR ≤3 and NLR >3 patients, respectively. Median survival time was 223 months for NLR ≤3 patients, whereas it was 118±66.11 (95%CI 0-247.58) for >3 patients. The 1-, 2-, 3- and 5- year survival rates were 92.6%, 86.4%, 82% and 72.3% for NLR ≤3 and 80.3%, 75.6%, 65% and 56.8% for NLR >3 patients, respectively, indicating statistical significance (p=0.047).

Conclusion: In NPC, a pre-treatment NLR above three indicates an unfavorable prognosis in survival and may be a valuable prognostic biomarker. A large-scale prospective study is necessary to validate the prognostic significance of NLR in NPC patients and to determine precise cut-off values.

Keywords: nasopharyngeal carcinoma, neutrophil-to-lymphocyte ratio, survival