Prognostic Value of Inflammatory Markers in Nasopharyngeal Carcinoma Patients in the Intensity-Modulated Radiotherapy Era

Purpose: Inflammatory markers have been widely used in various cancers, but rarely in nasopharyngeal carcinoma (NPC). Here, we evaluated the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), systemic immune index (SII), and systemic inflammation response index (SIRI) on NPC in the intensitymodulated radiotherapy (IMRT) era. Methods: We retrospectively analyzed data from NPC patients from the Renmin Hospital of Wuhan University, between January 2012 and July 2020. We used Chi-square test or Fisher's exact test to compare the baseline characteristics, then applied Kaplan-Meier (K-M) survival analysis to compare the overall survival (OS) and progression-free survival (PFS) rates. Multivariate Cox proportional risk models were applied to identify independent prognostic factors. Results: We enrolled a total of 342 NPC patients and found optimal cut-off values of 2.65, 184.91, 804.08, and 1.34 for NLR, PLR, SII, and SIRI, respectively. K-M survival analysis revealed that high NLR, PLR, SII, and SIRI were significantly associated with worse OS and PFS relative to those in the low groups. Results from univariate Cox analysis showed that clinical, T, and M stages, as well as NLR, PLR, SII, and SIRI were associated with OS, whereas age, alongside the aforementioned parameters, was associated with PFS. Moreover, multivariate Cox analysis showed that age >49 years (HR=2.48, 95% CI=1.21-5.05, P=0.013) and M1 stage (HR=3.84, 95% CI=1.52-9.73, P=0.013) were independent prognostic factors for OS, whereas SIRI >1.34 (HR=1.91, 95% CI=1.05-3.47, P=0.034) and M1 stage (HR=2.91, 95% CI=1.44-5.86, P=0.003) were independent prognostic factors for PFS. Conclusion: Overall, our findings indicated that high NLR, PLR, SII, and SIRI were significantly associated with poor OS and PFS in NPC patients. High SIRI may be an independent risk factor for PFS of NPC patients in the IMRT era. Keywords: nasopharyngeal carcinoma, neutrophil-to-lymphocyte ratio, platelet-tolymphocyte ratio, systemic immune inflammation index, systemic inflammatory response