Monocyte-to-lymphocyte ratio as a prognostic indicator in head and neck squamous cell carcinoma treated with radiotherapy

Background: The monocyte-to-lymphocyte ratio (MLR) has been reported as a useful prognosticator in various types of cancers. We studied the usefulness of MLR as a prognosticator for head and neck squamous cell carcinoma (HNSCC) in patients with oropharyngeal, hypopharyngeal, and laryngeal cancer who received radical concurrent chemoradiotherapy (CRT) or bioradiotherapy (BRT). Materials and Methods: This study included 76 HNSCC patients diagnosed between January 2015 and April 2020. We obtained their haematological records within one month before radiotherapy and calculated the MLR. Kaplan-Meier method and Cox proportional hazard model were performed to evaluate the association of MLR with locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS). Results: The Kaplan-Meier survival analysis for MLR showed a significant difference (p = 0.0326) in OS. Univariate and multivariate analysis revealed that the lower MLR group was associated with better OS (hazard ratio [HR] = 0.345, 95 % confidence interval [CI] = 0.124-0.960, p = 0.042 and HR = 0.305, 95% CI = 0.102-0.916, p = 0.034, respectively). Multivariate analysis also revealed that N 2-3 was significant independent predictor of LFRS and PFS (HR = 4.47, 95% CI = 1.43-14.0, p = 0.0286 and HR = 4.94, 95% CI = 1.8413.2, p < 0.01, respectively). Conclusion: MLR was useful as a prognostic predictor for OS in patients with HNSCC who received radical concurrent CRT or BRT. MLR may be more reflective of OS than of LRFS or PFS.