Combined pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts survival and prognosis in patients with non-metastatic nasopharyngeal carcinoma: a retrospective, multicenter clinical study

Abstract

Abstract Background Local recurrence and distant metastasis is the main cause of treatment failure in nasopharyngeal carcinoma (NPC). It is necessary to find a reliable, economical and convenient prognostic indicator to accurately predict the prognosis of NPC. The clinical significance of the combination of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) is unclear. This study investigated the predictive value of pretreatment NLR (pre-NLR) combined with pretreatment PLR (pre-PLR) for the survival and prognosis of NPC. Methods We retrospectively analyzed 765 patients with non-metastatic NPC. The NLR and PLR before treatment were examined. The pre-NLR-PLR scoring criteria and grouping were as follows: HRG, score of 2, high pre-NLR and high pre-PLR. MRG, score of 1, either high pre-NLR or high pre-PLR. LRG, score of 0, neither high pre-NLR nor high pre-PLR. We compared survival rates and factors affecting the prognosis among different groups. Receiver operating characteristic (ROC) curves were used to identify the cutoff-value and discriminant performance of the model. Results The ROC curve indicated a cut-off value of 3.29 for pre-NLR and 196.74 for pre-PLR. The 5-year overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) of NPC patients in HRG were significantly poorer than those in MRG and LRG. The pre-NLR-PLR score was positively correlated with T stage, clinical stage, ECOG score and pathological classification. Multivariate cox regression analysis showed that pre-NLR-PLR scoring system, ECOG score and pre-ALB were independent risk factors affecting 5-year OS, 5-year LRFS and 5-year DMFS in NPC patients. Age, T stage, smoking history were independent risk factors for 5-year OS. Age, pathological type, smoking history were independent risk factors for 5-year LRFS. T stage and N stage were independent risk factors for 5-year DMFS. The ROC curve showed that area under the curve (AUC) values of pre-NLR-PLR of 5-year OS, LRFS and DMFS in NPC were higher than those of pre-NLR and pre-PLR. Conclusions pre-NLR-PLR is an independent risk factor for the prognosis of NPC. The pre-NLR-PLR scoring system can be used as an individualized clinical assessment tool to predict the prognosis of patients with non-metastatic NPC more accurately and easily.