7th ICHNO Abstract book

7th ICHNO 7 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 14 – 16 March 2019 Barcelona, Spain __________________________________________________________________________________________ page 97

maximal impact in models for the risk of local-regional and distant recurrences (fig. 2).

tumor-driven expression of this immune checkpoint as a pathogenic mechanism for cancer development and progression, and pins point PD-1-specific immune checkpoint inhibition as a further therapeutic strategy in OSSC. PO-184 Low neutrophil-to-lymphocyte ratio is a negative prognosticator in oral squamous cell carcinoma D.Mattavelli 1 , D. Lombardi 1 , F. Missale 2 , S. Calza 3 , S. Battocchio 4 , A. Paderno 1 , A. Bozzola 4 , W. Vermi 4 , C. Piazza 5 , P. Nicolai 1 Spedali Civili-University of Brescia, Unit of Otorhinolaryngology - Head and Neck Surgery- Department of Surgical Specialties- Radiological Sciences- and Public Health, Brescia, Italy; 2 University of Genoa, Unit of Otorhinolaryngology- Head and Neck Surgery- Department of Surgical and Diagnostic Integrated Sciences, Genoa, Italy; 3 University of Brescia, Unit of Biostatistics and Biomathematics and Unit of Bioinformatics- Department of Molecular and Translational Medicine, Brescia, Italy; 4 Spedali Civili- University of Brescia, Unit of Pathology- Department of Molecular and Translational Medicine, Brescia, Italy; 5 Fondazione IRCCS- National Cancer Institute of Milan- University of Milan, Unit of Otorhinolaryngology – Head and Neck Surgery- Department of Surgery, Milan, Italy Purpose or Objective To explore the prognostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR) in a series of primary oral squamous cell carcinoma (OSCC), and develop All treatment-naive patients with OSCC treated with upfront surgery between 2000 and 2014 were retrospectively reviewed. Exclusion criteria were: presence of distant metastasis and/or synchronous head and neck cancer; previous chemotherapy for any cancer and/or radiotherapy in the head and neck area; immunological disorders or immunosuppressed status. Main outcomes were overall survival (OS), disease-specific survival (DSS), loco-regional free survival (LRFS), and distant metastasis free survival (DMFS). Univariate (Kaplan-Meier) and multivariate (Cox regression model) analysis were performed, and nomograms were developed for each outcome. NLR was analyzed as a continuous variable using restricted cubic spline multivariable Cox regression models. Results 182 patients were included. Five-year estimates for LRFS, DMFS, DSS, and OS were 67%, 83.7%, 69.5%, and 61.2%, respectively. NLR had a complex influence on survival and risk of recurrence: negative for very low and higher values, and positive in case of intermediate ratios (fig. 1). At univariate analysis, T classification, 7 th AJCC stage, nodal metastasis, perineural spread, and lymphovascular invasion were statistically significant. At multivariate analysis, extranodal extension (ENE) was the most powerful independent prognostic factor (LRFS, HR 4.08, p=<0.001; DMFS, HR 6.82, p<0.001; DSS, HR 5.97, p<0.001; OS, HR 3.83, p<0.001). Perineural spread impacted on the risk of distant metastasis (HR 4.39, p=0.002), and consequently on the risk of cancer-related death (HR 2.02, p=0.025). NLR was an independent prognosticator for the risk of recurrence (LRFS, p=0.005; DMFS, p=0.046), while the influence on DSS was close to significance (p=0.078). In nomograms, NLR and ENE displayed the highest prognostic effect; in particular, low values of NLR had prognostic nomograms. Material and Methods

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Conclusion In several studies on head and neck cancer, NLR has been analyzed as a dichotomic variable, and a negative impact of higher values has been consistently reported. In the current study, NLR was analyzed as a continuous variable, which enabled us to assess the complex influence of this parameter on survival estimates. In fact, very low preoperative NLR values have a negative prognostic impact, which is similar (if not superior) to high ratios. This finding is previously unreported in head and neck cancers. In nomograms, the prognostic effect of NLR is notable (mostly for the risk of recurrence) and overlaps that of major clinical-pathological factors, such as ENE. Overall, our findings support NLR as a powerful prognosticator in OSCC; nomograms can be an effective tool to identify high-risk patients and improve personalization of treatment.