ASSOCIATION OF PREOPERATIVE SYSTEMIC INFLAMMATORY MARKERS (NLR, PLR, AND LMR) WITH PATHOLOGICAL TUMOR STAGE AND CERVICAL LYMPH NODE METASTASIS IN ORAL SQUAMOUS CELL CARCINOMA

Abstract

Objective: To analyze the correlation between preoperative inflammatory blood markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) with pathological tumor stage and neck node metastasis in patients suffering from oral squamous cell carcinoma (OSCC), concomitantly to check their ability to diagnose nodal involvement in such patients.

Study Design: Analytical Cross-Sectional Study.

Study Duration: From January 2022 to January 2023.

Study Setting: ENT, Head and Neck Surgery Department of one of the tertiary hospitals in Karachi, Pakistan.

Methods: Total of 120 patients diagnosed with the primary OSCC through histopathological examination were included in the study who underwent primary surgery and neck dissection procedures. Preoperative blood samples had been collected within a week prior to the surgery, and levels of preoperative inflammatory parameters such as NLR, PLR, and LMR were estimated from the results of the blood examination. The pathological stage of tumor and nodal involvement was determined according to the eighth edition of the AJCC staging system. Comparison of inflammatory parameters of the patients was done using Mann-Whitney U test and diagnostic ability of each inflammatory parameter was calculated using ROC analysis.

Results:  The average age of the patients involved in the study is 52.4± 10.1 years, 82 patients were male (68.3%) and 38 patients were female (31.7%). Patients with advanced pathologic T-stage were 62 (51.7%) and patients with cervical lymph node metastasis were 54 (45.0%). Advanced T-stage patients had higher median NLR (3.28 vs. 2.04) and PLR (152.3 vs. 116.5) whereas their LMR was lower (2.45 vs. 3.98); all differences were found statistically significant (p<0.001). The same differences regarding NLR and LMR may be noticed in the group of nodal positive-sk and node-negative patients. The highest diagnostic capacity among three biomarkers was shown for NLR (AUC=0.84), followed by LMR (AUC=0.81) and PLR (AUC=0.74).

Conclusion: NLR, PLR and LMR levels before operations correlates with the tumor pathology stage and status of cervical lymph nodes. NLR showed the strongest diagnostic capabilities in identifying lymph node involvement among three studied biomarkers. The results of the study suggested that the inflammatory markers related to the patient’s status can help improve the quality of preoperative assessment of patients with OSCC.