Correlation between Nutritional Status and Neutrophil/Lymphocyte Ratio in Patients being Treated for Head and Neck CancerA Prospective Observational Study

Abstract

Introduction: It is a well known fact that diverse nutritional issues are associated with advanced Head and Neck Squamous Cell Cancer (HNSCC). In addition to poor nutrition, varying degrees of immunocompromisation has been noted in these patients and hence is important to study malnutrition and systemic immunity together. Aim: To determine correlation between nutritional status and systemic immunity in patients being treated for HNSCC. Materials and Methods: A prospective observational study was conducted at Cancer Research Institute (CRI) Dehradun, India for a period of 30 months (December 2018 and June 2021). A total of 159 HNSCC patients planned for treatment, were enrolled in the study. Data was collected pre-and posttreatment for disease based on the parameters- Performance Status (PS), nutritional status (weight, Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC) and haemoglobin. Subjective Global Assessment (SGA) Score and systemic immunity {Neutrophil/Lymphocyte Ratio (NLR)} were measured too. Analysis was planned for node negative (N-) and node positive (N+) groups. One-sample Kolmogorov-Smirnov test was used to check for normality of data, parametric and non parametric tests were used for association, Cochran's and Mantel-Haenszel Statistic was used to calculate Risk Ratio (RR), Pearson’s and Spearman’s coefficient test was used to assess the correlation. A p-value <0.05 was considered significant. Results: Total 159 patients were analysed, 72 in N- and 87 in N+ group. Mean age was 56.3±13.27 years, 142 (89.3%) patients were males, 57 (35.8%) patients were cT1/2, 97 (61%) cT3/4 and 5 (3.2%) cTx stage, 146 (92%) were PS 0-2 and 104 (65.4%) received multi-modality treatment. In pretreatment, malnutrition was found in 75 (47.2%) patients and median NLR was 3 (range 1-37). In N+ patients, median NLR was significantly higher in patients with ≥10% pretreatment weight loss, low MUAC and high SGA score pretreatment; in N- patients this association was present with only PS. A mild but statistically significant linear correlation was found for NLR with % pretreatment weight loss, BMI, haemoglobin; moderate correlation with weight, MUAC and SGA score in N+ group, but not in N- group. Conclusion: Poor nutritional status was significantly associated with raised NLR in node positive HNSCC patients with mild to moderate correlation, but this was not found in the node negative group.