Esra ZEYNELGİL, Gökşen İnanç İMAMOĞLU, İsmail DİLLİ, Mehmet Can ATAK, Doğan YAZILITAŞ, Ömer BAYIR, Abdülkadir KOÇANOĞLU, Engin Eren KAVAK
Journal of Oncological Sciences - 2025;11(3):259-268
Objective: Systemic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and hemoglobin-albumin-lymphocyte-platelet score (HALP) have been associated with prognosis in patients with head and neck cancer (HNC). However, the prognostic impact of their dynamic changes during induction chemotherapy has not been well established. Material and Methods: We retrospectively analyzed 84 patients with histologically confirmed head and neck squamous cell carcinoma who had received induction chemotherapy. Treatment response was evaluated according to RECIST 1.1. Objective response rate (ORR) was defined as the proportion of patients achieving a complete or partial response. Changes in NLR, PLR, LMR, neutrophil-to-monocyte ratio (NMR), SII, and HALP score between baseline and post-induction were categorized as increased or not increased. Logistic regression was used to assess associations with ORR, whereas Cox regression was used to evaluate progression-free survival (PFS) and overall survival (OS). Results: The median follow-up was 16.7 months. The ORR was 77.4%; 7 patients achieved a complete response, 58 achieved a partial response, 17 had stable disease, and 2 had progressive disease. Multivariate analysis demonstrated that increased NLR was independently associated with a lower ORR [odds ratio: 0.24, 95% confidence interval (CI): 0.08-0.75, p=0.014]. For survival outcomes, increased NLR [hazard ratio (HR): 0.13, 95% CI: 0.04-0.43, p<0.001) and decreased LMR (HR: 0.27, 95% CI: 0.09-0.83, p=0.022) predicted longer PFS. Increased NLR showed a borderline association with OS (HR=0.29; 95% CI: 0.08-1.00; p=0.050). Other indices, including PLR, NMR, SII, and HALP, were not statistically significant. Conclusion: Dynamic changes, particularly in NLR and LMR during induction chemotherapy, are independent prognostic factors for PFS in HNC. These findings support incorporating longitudinal monitoring of inflammatory indices into routine clinical practice.
