Vol 26, No 6 (2021)
Research paper
Published online: 2021-11-17

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The prognostic value of red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in radiotherapy for oropharyngeal cancer

Emilia Staniewska1, Bartłomiej Tomasik2, Rafał Tarnawski1, Mateusz Łaszczych2, Marcin Miszczyk1
Rep Pract Oncol Radiother 2021;26(6):1010-1018.


Background: Red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are known inflammatory indices. Elevated values are found in many cancers and may be associated with a poor prognosis. The article aimed to assess the impact of RDW, NLR, and PLR on overall survival (OS) of patients with oropharyngeal cancer treated with radiotherapy (RT).

Materials and methods: This retrospective study includes 208 patients treated for oropharyngeal cancer with definitive RT or RT combined with neoadjuvant or concurrent systemic therapy, at one institution between 2004 and 2014. The receiver operating characteristic (ROC) method, log-rank testing, and Cox proportional hazards regression model were used for the analysis.

Results: The OS was significantly higher in RDW ≤ 13.8% (p = 0.001) and NLR ≤ 2.099 (p = 0.016) groups. The RDW index was characterized by the highest discriminatory ability [area under the curve (AUC) = 0.59, 95% confidence interval (CI): 0.51–0.67], closely followed by NLR (AUC = 0.58, 95% CI: 0.50–0.65). In the univariate Cox regression analysis, RDW [hazard ratio (HR): 1.28, 95% CI: 1.12–1.47, p < 0.001] and NLR (HR: 1.11, 95% CI: 1.06–1.18, p < 0.001) were associated with an increased risk of death. In the multivariate analysis, among the analyzed indices, only NLR was significantly associated with survival (HR: 1.16, 95% CI: 1.03–1.29, p = 0.012).

Conclusions: In the study, only NLR proved to be an independent predictor of OS. However, its clinical value is limited due to the relatively low sensitivity and specificity.


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  1. Kawecki A., Nawrocki S. (ed). Nowotwory nabłonkowe narządów głowy i szyi . http://onkologia.zalecenia.med.pl/pdf/zalecenia_PTOK_tom1_01_Nowotwory_nablonkowe_glowy_i_szyi_20140807.pdf.
  2. Wojciechowska U, Czaderny K, Ciuba A, et al. Cancer in Poland — 2016. http://onkologia.org.pl/wp-content/uploads/Nowotwory_2016.pdf (2018).
  3. Hansen EK, Roach M. Handbook of evidence-based radiation oncology. Springer Science, New Yor 2018: 1–969.
  4. Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015; 52(2): 86–105.
  5. Lippi G, Plebani M. Red blood cell distribution width (RDW) and human pathology. One size fits all. Clin Chem Lab Med. 2014; 52(9): 1247–1249.
  6. Argilés JM. Cancer-associated malnutrition. Eur J Oncol Nurs. 2005; 9 Suppl 2: S39–S50.
  7. Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016; 4(20): 399.
  8. Xu WY, Yang XB, Wang WQ, et al. Prognostic impact of the red cell distribution width in esophageal cancer patients: A systematic review and meta-analysis. World J Gastroenterol. 2018; 24(19): 2120–2129.
  9. Pedrazzani C, Tripepi M, Turri G, et al. Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients. Sci Rep. 2020; 10(1): 1072.
  10. Yazici P, Demir U, Bozkurt E, et al. The role of red cell distribution width in the prognosis of patients with gastric cancer. Cancer Biomarkers. 2017; 18(1): 19–25.
  11. Huang DP, Ma RM, Xiang YQ. Utility of Red Cell Distribution Width as a Prognostic Factor in Young Breast Cancer Patients. Medicine (Baltimore). 2016; 95(17): e3430.
  12. Miszczyk M, Jabłońska I, Magrowski Ł, et al. The association between RDW and survival of patients with squamous cell carcinoma of the tongue. Simple, cheap and convenient? Rep Pract Oncol Radiother. 2020; 25(4): 494–499.
  13. Wang Q, Ma J, Jiang Z, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. 2018; 37(1): 4–11.
  14. Gasparyan AY, Ayvazyan L, Mukanova U, et al. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019; 39(4): 345–357.
  15. Liu CC, Ko HJ, Liu WS, et al. Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Baltimore). 2019; 98(43): e17537.
  16. Diem S, Schmid S, Krapf M, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017; 111: 176–181.
  17. Prabawa IP, Bhargah A, Liwang F, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019; 20(3): 863–868.
  18. Sun Y, Zhang L. The clinical use of pretreatment NLR, PLR, and LMR in patients with esophageal squamous cell carcinoma: evidence from a meta-analysis. Cancer Manag Res. 2018; 10: 6167–6179.
  19. Skladowski K, Maciejewski B, Golen M, et al. Continuous accelerated 7-days-a-week radiotherapy for head-and-neck cancer: long-term results of phase III clinical trial. Int J Radiat Oncol Biol Phys. 2006; 66(3): 706–713.
  20. Miszczyk L, Maciejewski B, Tukiendorf A, et al. Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients-final results of a randomized clinical trial. Br J Radiol. 2014; 87(1041): 20140212.
  21. Edge SB. AJCC Cancer Staging Manual 7th Edition. 7th ed. Springer International Publishing, London 2010.
  22. Youden WJ. Index for rating diagnostic tests. Cancer. 1950; 3(1): 32–35, doi: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3.
  23. Wang DP, Kang K, Lin Qi, et al. Prognostic Significance of Preoperative Systemic Cellular Inflammatory Markers in Gliomas: A Systematic Review and Meta-Analysis. Clin Transl Sci. 2020; 13(1): 179–188.
  24. Hsueh CY, Lau HC, Li S, et al. Pretreatment level of red cell distribution width as a prognostic indicator for survival in a large cohort study of male laryngeal squamous carcinoma. Frontiers in Oncology; 9. Epub ahead of print 2019. Front Oncol. 2019; 9: 271.
  25. Ge W, Xie J, Chang L. Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma. Cancer Manag Res. 2018; 10: 3611–3618.
  26. Ye L, Oei RW, Kong F, et al. Prognostic values of hematological biomarkers in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Eur Arch Otorhinolaryngol. 2018; 275(5): 1309–1317.
  27. Xun Y, Wang M, Sun H, et al. Prognostic Analysis of Preoperative Inflammatory Biomarkers in Patients With Laryngeal Squamous Cell Carcinoma. Ear Nose Throat J. 2020; 99(6): 371–378.
  28. Bojaxhiu B, Templeton AJ, Elicin O, et al. Relation of baseline neutrophil-to-lymphocyte ratio to survival and toxicity in head and neck cancer patients treated with (chemo-) radiation. Radiat Oncol. 2018; 13(1): 216.
  29. Szilasi Z, Jósa V, Zrubka Z, et al. Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours-Results of a Retrospective Multicentric Study. Int J Environ Res Public Health. 2020; 17(5).
  30. Young CA, Murray LJ, Karakaya E, et al. The Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Oropharyngeal Carcinoma Treated with Chemoradiotherapy. Clin Med Insights Oncol. 2014; 8: 81–86.

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