Preoperative Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Oral Squamous Cell Carcinoma: A Large-Sample Prospective Study

Purpose: To assess and determine the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with oral squamous cell carcinoma (OSCC). Materials and Methods: The prospective study involving 1,202 patients with OSCC and surgical resection was carried out in Fujian, China. Two-stage analyses were performed by randomly dividing all patients into 800 discovery and 402 replication sets. The optimal NLR cutoff points were identified by the X-tile program with minimum P values. Prognostic factors were evaluated using univariate and multivariate Cox regression models. Results: The discovery set was categorized as low-, middle-, and high-risk groups based on optimal NLR cutoff points (< 1.94, 1.94 to 3.66, and > 3.66, respectively). A high NLR was meaningfully associated with an increased risk of death on survival (NLR 1.94 to 3.66, hazard ratio [HR] = 1.51; 95% confidence interval [CI], 1.09-2.08; NLR >3.66, HR = 1.76; 95% CI, 1.21-2.55). In the replication phase, patients with a high NLR showed considerably worse overall survival compared with those with a low NLR (NLR 1.94 to 3.66, HR = 1.61; 95% CI, 1.02-2.55; NLR >3.66, HR = 1.94; 95% CI, 1.16-3.27). In addition, better overall survival was observed for patients with a higher NLR who had received postoperative chemoradiotherapy (HR = 0.49; 95% CI, 0.26-0.92). Conclusion: The preoperative NLR is an independent factor in predicting the prognosis of OSCC, especially for patients with chemoradiotherapy, which could serve as a potential target for improving patients' prognosis. (C) 2016 American Association of Oral and Maxillofacial Surgeons