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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Department of Internal Medicine, Faculty of Medicine Universitas Indonesia
2021-09-01
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| Series: | Jurnal Penyakit Dalam Indonesia |
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| Online Access: | http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/618/285 |
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| author | Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan |
| author_facet | Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan |
| author_sort | Rahmat Cahyanur |
| collection | DOAJ |
| 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 |
| id | doaj-art-052ef222eead4a6aa8eea8ec9a75b5ea |
| institution | OA Journals |
| issn | 2406-8969 2549-0621 |
| language | Indonesian |
| publishDate | 2021-09-01 |
| publisher | Department of Internal Medicine, Faculty of Medicine Universitas Indonesia |
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| series | Jurnal Penyakit Dalam Indonesia |
| spelling | doaj-art-052ef222eead4a6aa8eea8ec9a75b5ea2025-08-20T02:01:09ZindDepartment of Internal Medicine, Faculty of Medicine Universitas IndonesiaJurnal Penyakit Dalam Indonesia2406-89692549-06212021-09-0183146150http://dx.doi.org/10.7454/jpdi.v8i3.618Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal CarcinomaRahmat Cahyanur0Hayatun Nufus1Cosphiadi Irawan2Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo General Hospital IndonesiaDepartment of Internal Medicine, Persahabatan General Hospital, Jakarta Indonesia Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo General Hospital, Jakarta Indonesia 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.http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/618/285nasopharyngeal carcinomaneutrophil lymphocyte ratiosurvival |
| spellingShingle | Rahmat Cahyanur Hayatun Nufus Cosphiadi Irawan Neutrophil Lymphocyte Ratio, Three Year Survival of Locally Advanced and Advanced Nasopharyngeal Carcinoma Jurnal Penyakit Dalam Indonesia nasopharyngeal carcinoma neutrophil lymphocyte ratio survival |
| title | 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_short | 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 |
| topic | nasopharyngeal carcinoma neutrophil lymphocyte ratio survival |
| url | http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/618/285 |
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