Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma

Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the...

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Autores principales:	Rahmat Cahyanur, Hayatun Nufus, Cosphiadi Irawan
Formato:	article
Lenguaje:	ID
Publicado:	Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital 2021
Materias:	nasopharyngeal carcinoma neutrophil lymphocyte ratio survival Internal medicine RC31-1245
Acceso en línea:	http://dx.doi.org/10.7454/jpdi.v8i3.618 https://doaj.org/article/052ef222eead4a6aa8eea8ec9a75b5ea
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spelling	oai:doaj.org-article:052ef222eead4a6aa8eea8ec9a75b5ea2021-11-17T14:05:47ZNeutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinomahttp://dx.doi.org/10.7454/jpdi.v8i3.6182406-89692549-0621https://doaj.org/article/052ef222eead4a6aa8eea8ec9a75b5ea2021-09-01T00:00:00Zhttp://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/618/285https://doaj.org/toc/2406-8969https://doaj.org/toc/2549-0621Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients. Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status. Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariate analysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival. Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.Rahmat CahyanurHayatun NufusCosphiadi IrawanDepartment of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospitalarticlenasopharyngeal carcinomaneutrophil lymphocyte ratiosurvivalInternal medicineRC31-1245IDJurnal Penyakit Dalam Indonesia, Vol 8, Iss 3, Pp 146-150 (2021)
institution	DOAJ
collection	DOAJ
language	ID
topic	nasopharyngeal carcinoma neutrophil lymphocyte ratio survival Internal medicine RC31-1245
spellingShingle	nasopharyngeal carcinoma neutrophil lymphocyte ratio survival Internal medicine RC31-1245 Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
description	Introduction. Nasopharyngeal carcinoma (NPC) is the most prevalent head and neck malignancy in Indonesia, as NPC-related mortality in Indonesia is the second-highest in Asia after China. Inflammation has been studied to be associated with cancer progression. Neutrophil lymphocyte ratio describes the balance between the unfavorable suppression of immune response against cancer by neutrophils and the beneficial effect of adaptive immunity by lymphocytes. This study aimed to determine the relationship between NLR and the survival of locally advanced and advanced NPC patients. Methods. A retrospective cohort study was conducted using the medical records of NPC patients treated at the hematology clinic RSCM from 2015 to 2018. The difference in 3-year survival between NPC patients with and without metastasis, also high and low NLR, was analyzed with the Kaplan-Meier method. At the same time, multivariate Cox regression analysis was used to obtain adjusted hazard ratios (HR) after comparing with patients’ age, gender, T stage, N stage, NLR level, and metastasis status. Results. There were 143 patients included in this study; a total of 49 (34.3%) had metastasis. There was a significant difference in survival between those with and without metastasis (p=0.001), with 3-year survival of 24.5% in patients with metastasis. The AUC of NLR was 0.600 (CI 95% 0.502—0.698; p=0.049). The optimal cut-off value determined for NLR was 4.7 with a sensitivity of 56.00%, specificity of 62.37%, PPV of 59.81%, and NPV of 58.64% in predicting survival. Based on that value (≥4,7), there was a significant difference in proportion between those with and without metastasis (63.3% vs. 33.0%, p=0.001). Multivariate analysis showed that metastasis (HR 3.349, CI 95% 1.909—5.874, p<0.001) was associated with poorer survival. Conclusions. There was no association between NLR and 3-year survival in NPC patients. The proportion of subjects with high NLR was found higher in those with metastasis. Metastasis status was associated with 3-year survival.
format	article
author	Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan
author_facet	Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan
author_sort	Rahmat Cahyanur
title	Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
title_short	Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
title_full	Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
title_fullStr	Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
title_full_unstemmed	Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma
title_sort	neutrophil lymphocyte ratio, three year survival of locally advanced and advanced nasopharyngeal carcinoma
publisher	Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital
publishDate	2021
url	http://dx.doi.org/10.7454/jpdi.v8i3.618 https://doaj.org/article/052ef222eead4a6aa8eea8ec9a75b5ea
work_keys_str_mv	AT rahmatcahyanur neutrophillymphocyteratiothreeyearsurvivaloflocallyadvancedandadvancednasopharyngealcarcinoma AT hayatunnufus neutrophillymphocyteratiothreeyearsurvivaloflocallyadvancedandadvancednasopharyngealcarcinoma AT cosphiadiirawan neutrophillymphocyteratiothreeyearsurvivaloflocallyadvancedandadvancednasopharyngealcarcinoma
_version_	1718425459987841024

Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma

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