Prognostic value of pre- and post-treatment neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios in nasopharyngeal carcinoma.

Blood cell count ratios are useful prognostic indicators in cancer. The present retrospective study evaluated the levels of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) across different treatment phases and their potential prognostic value in nasopharyngeal carcinoma. A total of 99 patients were treated with induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT). Biomarkers were assessed at three separate time points: Pre-IC, pre-CCRT and post-radiation therapy (RT). Results indicated that the NLR and PLR values were higher, while the LMR values were lower at later chronological time points, particularly post-RT. Post-RT, higher NLR and PLR levels and a lower LMR level were observed in non-survivors. Being ≥60 years old was associated with lower odds of elevated PLR post-RT and experiencing weight loss ≥7.5% predicted increased NLR post-RT. Elevated pre-IC and post-RT PLR was associated with reduced 5-year overall survival. Multivariate analysis, although limited by the small number of events (n=15), identified PLR pre-IC and advanced nodal stage (N3) as independent mortality predictors. PLR pre-IC and N3 stage may therefore serve as preliminary independent predictors of poor prognosis, supporting the use of inflammatory biomarkers for risk stratification. Despite this, prospective external validation in larger cohorts is required.