Significance of neutrophil to lymphocyte ratio as a predictor of outcome in head and neck cancer treated with definitive chemoradiation

[18F]FDG PET/CT Imaging and Hematological Parameters Can Help Predict HPV Status in Head and Neck Cancer

OBJECTIVE

To determine whether [18F]FDG PET/CT and hematological parameters provide supportive data to determine HPV status in HNSCC patients.

METHODS

Retrospective analysis of clinical and diagnostic data from 106 patients with HNSCC: 26.4% HPV-positive and 73.6% HPV-negative was performed. The following semiquantitative PET/CT parameters for the primary tumor and hottest lymph node and liver were evaluated: SUVmax, SUVmean, TotalSUV, MTV, TLG, maximum, mean and TLG tumor-to-liver ratio (TLRmax, TLRmean,TLRTLG) and heterogeneity index (HI). Following hematological variables were assessed: white blood cell (WBC); lymphocyte (LYMPH); neutrophil (NEU),monocyte (MON); platelet (PLT); neutrophil-to-lymphocyte ratio (NRL); lymphocyte-to-monocyte ratio (LMR); platelet-to lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR). Conventional statistical analyses were performed in parallel with an artificial neural network analysis (Neural Analyzer, v. 2.9.5).

RESULTS

Significant between-group differences were observed for two of the semiquantitative PET/CT parameters, with higher values in the HPV-negative group: primary tumor MTV (22.2 vs 9.65; p=0.023), and TLRmax (3.50 vs 2.46; p=0.05). The HPV-negative group also had a significantly higher NEU count (4.84 vs. 6.04; p=0.04), NEU% (58.2 vs. 66.2; p=0.007), and NRL% (2.69 vs. 3.94; p=0.038). Based on ROC analysis (sensitivity 50%, specificity 80%, AUC 0.5), the following variables were independent predictors of HPV-negativity: primary tumor with SUVmax >10; TotalSUV >2800; MTV >23.5; TLG >180; TLRmax >3.7; TLRTLG >5.7; and oropharyngeal localization.

CONCLUSION

Several semiquantitative parameters derived from [18F]FDG PET/CT imaging of the primary tumor (SUVmax, TotalSUV, MTV, TLG, TLRmax and TLRTLG) were independent predictors of HPV-negativity.

Chloride intracellular channels in oncology as potential novel biomarkers and personalized therapy targets: a systematic review

Background

The chloride intracellular channels (CLICs) family includes six ion channels (CLIC1-CLIC6) expressed on the cellular level and secreted into interstitial fluid and blood. They are involved in the physiological functioning of multiple systems as well as the pathogenetic processes of cancer. CLICs play essential roles in the tumor microenvironment. The current systematic review aimed at identifying and summarizing the research of CLICs in oncology on clinical material to assess CLICs' potential as novel biomarkers and personalized therapy targets.

Materials and methods

The authors systematically searched the PubMed database for original articles concerning CLIC research on clinical material of all types of cancer - fluids and tissues.

Results

Fifty-three articles investigating in summary 3944 clinical samples were qualified for the current review. Studied material included 3438 tumor samples (87%), 437 blood samples (11%), and 69 interstitial fluid samples (2%). Studies investigated 21 cancer types, mostly hepatocellular carcinoma, colorectal, ovarian, and gastric cancer. Importantly, CLIC1, CLIC2, CLIC3, CLIC4, and CLIC5 were differently expressed in cancerous tissues and patients' blood compared to healthy controls. Moreover, CLICs were found to be involved in several cancer-associated signaling pathways, such as PI3K/AKT, MAPK/ERK, and MAPK/p38.

Conclusion

CLIC family members may be candidates for potential novel cancer biomarkers due to the contrast in their expression between cancerous and healthy tissues and secretion to the interstitial fluid and blood. CLICs are investigated as potential therapeutic targets because of their involvement in cancer pathogenesis and tumor microenvironment.

T lymphocyte and neutrophil/lymphocyte ratio in patients with radiation-induced oral mucositis after intensity-modulated radiation therapy for head and neck cancer: A retrospective single-center study

To investigate T lymphocyte, neutrophil/lymphocyte ratio (NLR) and their impact on patients with radiation-induced oral mucositis (RIOM) after intensity-modulated radiotherapy for head and neck cancer. The clinical data of 148 patients diagnosed with head and neck cancer from January 2016 to January 2019 were retrospectively analyzed. Patients were divided into RIOM group (n = 42 cases) and non-RIOM group (n = 106 cases), based on whether they developed RIOM after intensity-modulated radiation therapy. The T lymphocyte and NLR of the 2 groups were analyzed before and after treatment; The correlation between T lymphocyte and NLR in RIOM group was analyzed. We used RTOG grading system to evaluate and scale the RIOM. The relationship between the grade of RIOM, T lymphocyte and NLR in RIOM group was analyzed. After treatment, the proportion of CD3 +, CD4 +, and CD8 + T lymphocytes in the 2 groups after treatment were decreased, and the RIOM group was significantly lower than non-RIOM group, P < .05. NLR in RIOM group was significantly higher than that in non-RIOM group, P < .05. The data of overall survival showed no significant differences between 2 groups (HR = 0.82, 95% CI: 0.43-1.59). Compared with RIOM group, patients in non-RIOM group showed a longer progress-free survival (HR = 0.57, 95% CI: 0.33-0.99). In RIOM group, NLR was negatively correlated with CD3 + (r = -0.433, P = .004), CD4 + (r = -0.644, P < .001) and CD8 + T cells (r = -0.665, P < .001). RIOM was positively correlated with NLR (R = 0.621, P < .001), negatively correlated with CD4 + T cell ratio (r = -0.449, P = .003) and CD8 + T cell ratio (r = -0.307, P = .048), but RIOM did not correlate with CD3 + T cell ratio (r = -0.225, P = .152). For patients with RIOM after intensity-modulated radiotherapy for head and neck cancer, T lymphocyte showed a downward trend, and NLR showed an upward trend. In addition, T lymphocyte and NLR are closely related to the RIOM, indicating that clinicians should be aware of the importance of T lymphocyte and NLR on patients received radiotherapy.

Current and Emerging Diagnostic, Prognostic, and Predictive Biomarkers in Head and Neck Cancer

Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.