Refining the role of preoperative C-reactive protein by neutrophil/lymphocyte ratio in oral cavity squamous cell carcinoma

Authors

  • Hsuan-Yeh Fang MD,

    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Xin Yong Huang MD,

    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    2. Department of Otolaryngology, Head and Neck Surgery, Changi General Hospital, Singapore
    Search for more papers by this author
  • Huei-Tzu Chien PhD,

    1. Department of Epidemiology, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
    Search for more papers by this author
  • Joseph Tung-Chieh Chang MD,

    1. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Chun-Ta Liao MD,

    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Jung-Ju Huang MD,

    1. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Fu-Chan Wei MD,

    1. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Hung-Ming Wang MD,

    1. Department of Medical Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • I-How Chen MD,

    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Chung-Jan Kang MD,

    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    Search for more papers by this author
  • Shiang-Fu Huang MD, PhD

    Corresponding author
    1. Department of Otolaryngology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan, Republic of China
    • Send correspondence to Dr. Shiang-Fu Huang, Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, at Linkou, Taiwan, No. 5, Fu-Shin Street, Kwei-Shan, Taoyuan 333, Taiwan, Republic of China. E-mail: shiangfu.huang@gmail.com

    Search for more papers by this author

  • This study was supported by grants CMRPG3A0282 from the Chang Gung Memorial Hospital and NSC99–2314-B-182A-036-MY3 from the National Science Council, Department Executive Yuan, Taiwan, Republic of China.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Elevated inflammatory biomarkers such as C-reactive protein (CRP) and the recently identified neutrophil/lymphocyte ratio (NLR) were demonstrated to be associated with prognosis in human cancers. The aim of our present study is to analyze the relationship of preoperative levels of CRP and NLR with clinicopathological factors and prognosis in oral squamous cell carcinoma (OSCC) patients.

Study Design

Retrospective study.

Methods

This study was performed on 226 OSCC patients between July 2007 and April 2012. Their serum CRP levels and NLR were measured preoperatively.

Results

CRP level ≥ 5.0 mg/L was significantly associated with NLR ≥ 2.44 (linear regression, P < .001). Elevated CRP and NLR were significantly associated with pathological tumor status (P < .001), pathologic nodal metastasis (P < .001), tumor depth (≥10 mm vs. <10 mm, P < .001), disease-free survival (P < .001), and overall survival (P = .001). The influence of CRP level and NLR on disease-free survival (hazard ratio [HR] = 2.259, 95% confidence interval [CI] = 1.170-4.361) and overall survival (HR = 2.176, 95% CI = 1.116-4.245]) still existed after adjusting for tumor status, lymph node metastasis, and tumor cell differentiation.

Conclusions

The present study demonstrates that elevated CRP is an independent prognostic factor in OSCC. Elevated NLR in the high CRP group identifies patients at high risks of recurrence and shorter survival. Incorporating NLR into CRP level therefore has significant potential as a biomarker for risk stratification in OSCC.

Level of Evidence

4. Laryngoscope, 123:2690–2699, 2013

Ancillary