The Prognostication of Surgically Resected Head and Neck Squamous Cell Carcinoma Using Pre‐Therapy Neutrophil and Lymphocyte Counts

ABSTRACT Background Hematological markers, such as neutrophils (ANC), lymphocyte (ALC), and neutrophil‐lymphocyte ratio (NLR), may serve as indicators of systemic inflammation and immune response in head and neck squamous cell carcinoma (HNSCC). However, their prognostic significance across HNSCC subtypes remains to be fully elucidated. Methods We conducted a secondary analysis of a randomized clinical trial involving patients with surgically resected HNSCC with either positive margins or extranodal extension. These patients received either adjuvant chemoradiation with or without lapatinib. We explored the correlation between pre‐therapy ANC, ALC, and NLR levels and overall survival (OS) as well as disease‐free survival (DFS). A sub‐group analysis examined potential links between these markers, primary tumor location, and HPV status. Results Of the 688 patients in the trial, we included 681 patients with documented pre‐therapy ANC and ALC values. High pre‐therapy ANC and ALC were significantly associated with reduced OS (HR, 1.56; 95% CI: 1.19–2.05) and (HR, 1.34; 95% CI: 1.01–1.79), respectively. High NLR did not significantly affect OS (HR, 1.09; 95% CI: 0.81–1.47). Subgroup analysis indicated significantly reduced OS in patients with high ANC across oropharyngeal, non‐oropharyngeal, and HPV‐negative subtypes. High ANC, ALC, and NLR did not impact DFS notably. Conclusion Elevated pre‐therapy ANC is strongly associated with decreased survival across all patients and subgroups, ALC was only significant in the general patient analysis. NLR's association with reduced OS was not statistically significant. These biomarkers may provide greater prognostic value in patients with oropharyngeal cancer and seemed to be more strongly associated with OS than DFS. Trial Registration Clinicaltrials.gov identifier: NCT00424255; URL: https://clinicaltrials.gov/ct2/show/study/NCT00424255