8d3f9e032f6dd40f342f1821a414fe76 pmc_9913392.pdf 572584bfe4c66c00c8a8a70741515e27b3c0c072 pmc_9913392.pdf 13ca4929242a4dac959d26264912ea2280049b10ca4c865b58483ffe92ec0b21 pmc_9913392.pdf Title: Neutrophil to Lymphocyte Ratio in Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis "2279 Subject: Neutrophil-to-lymphocyte ratio (NLR) has been associated with survival in various cancers, including head and neck cancer. However, there is limited information on its role in oropharyngeal squamous cell carcinomas (OPSCC) according to HPV status. This prompted the present meta-analysis. Studies were selected when the prognostic value of NLR prior to treatment was evaluated in OPSCC patients, the cutoff value of NLR was available, and the prognostic value of NLR was evaluated by time-to-event survival analysis. A total of 14 out of 492 articles, including 7647 patients, were analyzed. The results showed a worse prognosis for the patients with a high NLR: The combined hazard ratios (HR) for overall survival (OS) in patients with an elevated NLR was 1.56 (95% confidence interval (CI) 1.21–2.02; p = 0.0006), for disease-free survival was 1.52 (95% CI 1.34–1.73; p < 0.00001), and for recurrence-free survival was 1.86 (95% CI 1.50–2.30; p < 0.00001). This worse prognosis of high NLR was exclusive of HPV-positive patients: HR for OS in the HPV-positive subgroup was 4.05 (95% CI 1.90–8.62 (p = 0.0003), and in the HPV-negative subgroup 0.92 (95% CI 0.47–1.80; p = 0.82). The prognosis of NLR was not influenced by treatment: The HR for OS for patients treated with radiotherapy/chemoradiotherapy (RT/CRT) was 1.48 (95% CI 1.09–2.01; p = 0.01), and for patients treated with surgery (RT/CRT) was 1.72 (95% CI 1.08–2.72; p = 0.02). In conclusion, an elevated NLR relates to worse outcomes in patients with HPV-positive OPSCC. Keywords: oropharyngeal squamous cell carcinoma; meta-analysis; neutrophil-to-lymphocyte ratio; prognosis Author: Juan P. Rodrigo, Mario Sánchez-Canteli, Asterios Triantafyllou, Remco de Bree, Antti A. Mäkitie, Alessandro Franchi, Henrik Hellquist, Nabil F. Saba, Göran Stenman, Robert P. Takes, Cristina Valero, Nina Zidar and Alfio Ferlito Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sat Jan 28 07:32:17 2023 CET ModDate: Mon Jan 30 10:30:20 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2399250 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- AIQCCL+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 AZMWTB+VnURWPalladioL Type 1 Custom yes yes no 15 0 EIVSEL+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 ZGGLKJ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 DASHMU+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 TNBSFT+CMSY10 Type 1 Builtin yes yes no 69 0 MIJANA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 83 0 MIJAOC+PalatinoLinotype TrueType WinAnsi yes yes no 86 0 MIJAOE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 89 0 MIJANA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 109 0 MIJAOC+PalatinoLinotype TrueType WinAnsi yes yes no 112 0 MIJAOE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 115 0 MIJANA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 129 0 MIJAOC+PalatinoLinotype TrueType WinAnsi yes yes no 132 0 MIJAOE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 135 0 MIJANA+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 149 0 MIJAOB+PalatinoLinotype CID TrueType Identity-H yes yes yes 152 0 MIJAOC+PalatinoLinotype TrueType WinAnsi yes yes no 158 0 MIJAOE+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 161 0 LDSSDS+EURM10 Type 1 Builtin yes yes no 168 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-12 02:31:11 CEST RepresentationInformation: pmc_9913392.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-30 02:16:04 CEST Size: 2399250 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 447 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Data Source Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Study Selection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Data Extraction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Quality Assessment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Data Synthesis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Children: Item: Title: Literature Search and Included Studies Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Method of Obtaining the Cut-Off Value of NLR Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Impact of NLR on Survival in All Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Impact of NLR on Survival in HPV-Positive Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Impact of NLR on Survival in HPV-Negative Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Impact of NLR on Survival in All Patients by Treatment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Impact of Cut-Off Value of NLR on Survival in All Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Published Status Bias Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Info: Title: Neutrophil to Lymphocyte Ratio in Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis "2279 Author: Juan P. Rodrigo, Mario Sánchez-Canteli, Asterios Triantafyllou, Remco de Bree, Antti A. Mäkitie, Alessandro Franchi, Henrik Hellquist, Nabil F. Saba, Göran Stenman, Robert P. Takes, Cristina Valero, Nina Zidar and Alfio Ferlito Subject: Neutrophil-to-lymphocyte ratio (NLR) has been associated with survival in various cancers, including head and neck cancer. However, there is limited information on its role in oropharyngeal squamous cell carcinomas (OPSCC) according to HPV status. This prompted the present meta-analysis. Studies were selected when the prognostic value of NLR prior to treatment was evaluated in OPSCC patients, the cutoff value of NLR was available, and the prognostic value of NLR was evaluated by time-to-event survival analysis. A total of 14 out of 492 articles, including 7647 patients, were analyzed. The results showed a worse prognosis for the patients with a high NLR: The combined hazard ratios (HR) for overall survival (OS) in patients with an elevated NLR was 1.56 (95% confidence interval (CI) 1.21 2.02; p = 0.0006), for disease-free survival was 1.52 (95% CI 1.34 1.73; p < 0.00001), and for recurrence-free survival was 1.86 (95% CI 1.50 2.30; p < 0.00001). This worse prognosis of high NLR was exclusive of HPV-positive patients: HR for OS in the HPV-positive subgroup was 4.05 (95% CI 1.90 8.62 (p = 0.0003), and in the HPV-negative subgroup 0.92 (95% CI 0.47 1.80; p = 0.82). The prognosis of NLR was not influenced by treatment: The HR for OS for patients treated with radiotherapy/chemoradiotherapy (RT/CRT) was 1.48 (95% CI 1.09 2.01; p = 0.01), and for patients treated with surgery (RT/CRT) was 1.72 (95% CI 1.08 2.72; p = 0.02). In conclusion, an elevated NLR relates to worse outcomes in patients with HPV-positive OPSCC. 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