2Department of Radiation Oncology, Manisa City Hospital, Manisa-Türkiye DOI : 10.5505/tjo.2023.4017 OBJECTIVE
This study aimed to determine whether lymphopenia and neutrophil-to-lymphocyte ratio (NLR) could be prognostic factors of overall survival (OS), disease-free survival (DFS), or distant metastasis-free survival (DMFS) in patients with head-and-neck cancer (HNC) undergoing radical radiotherapy or chemoradiotherapy.
METHODS
Eighty-four patients" medical records with HNC who underwent radical radiotherapy/ concurrent
chemoradiotherapy were retrospectively included in the study. Blood tests were analyzed at the
treatment's beginning, middle, and end. The degree of lymphopenia was categorized according to the
Common Terminology Criteria for Adverse Events. The OS, DFS, and DMFS were calculated with the
Kaplan-Meier method. In addition, univariate and multivariate Cox regression analyses were used to
investigate the relationship between lymphopenia and survival.
RESULTS
The median follow-up time of patients was 20 months (range, 3-103). Forty-five deaths and a median
1-year OS of 76% were found. There was no difference in OS (median 27 months vs. 32 months,
p=0.674) and DFS (30 months vs. 31 months, p=0.350) between patients who developed and did not develop
lymphopenia during radiotherapy. However, survival was significantly worse in patients with G3
lymphopenia than in G1-2 patients (median 21 months vs. 49 months, p=0.033). When patients with an
NLR of ≥4.9 and <4.9 were compared, no difference in OS (p=0.156) and DFS (p=0.830) was observed
between these two groups. However, DMFS (43.1 months vs. 66.6 months, respectively, p=0.052) was
worse in patients with high NLR (≥4.9).
CONCLUSION
Treatment-related G3 lymphopenia and high NLR rate are poor prognostic factors in patients with HNC.