Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer

Objective: To investigate the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) for human papillomavirus–positive oropharyngeal cancer (HPV+ OPC). Study Design: Retrospective institutional database analysis. Setting: Tertiary referral medical center. Material and Methods: In total, 104 patients with HPV+ OPC were enrolled. From the blood laboratory data checked within 4 weeks before initiation of primary treatment, NLR was calculated. The association between clinicopathological characteristics and NLR was analyzed, and the prognostic role was evaluated based on overall survival (OS) and disease-free survival (DFS). Results: According to the cutoff value (2.42) for NLR, the patients were classified into the low NLR group (n = 61) or the high NLR group (n = 43). High NLR was associated with a higher rate of advanced T classification (P =.007) and diabetes mellitus (P =.01). The proportion of surgery-based treatment was lower in the high NLR group (20.9% vs 42.6%, P =.02). The high NLR group showed a lower 5-year OS rate (85.3% vs 96.3%, P =.09) and a lower 5-year DFS rate (68.1% vs 94.7%, P =.01) than those in the low NLR group. Multivariate analysis showed that advanced N classification was a significant predictor for worse 5-year OS (hazard ratio [HR], 17.40; 95% confidence interval [CI], 2.36-128.29) and that both advanced N classification (HR, 7.78; 95% CI, 2.33-25.93) and high NLR (HR, 4.16; 95% CI, 1.24-13.95) were important prognosticators for worse 5-year DFS. Conclusion: Elevated pretreatment NLR was associated with poor DFS in patients with HPV+ OPC.