BACKGROUND Inflammation and immune surveillance evasion are cancer hallmarks. Peripheral blood leukocytes (PBLs) represent both. The aim of the current study was to examine PBLs as predictors of outcomes in oral cavity squamous cell carcinoma (OSCC), and to find specific cutoffs with the goal of including PBLs as host factor in patients' preoperative risk assessment. METHODS Previously established head and neck squamous cell carcinoma (HNSCC) cutoffs were examined in an independent cohort of 1369 OSCC patients. Then optimal OSCC cutoffs were found and validated in the subset of patients with OSCC (n = 119) from the external HNSCC cohort. The PBLs analyzed were neutrophils, monocytes, and lymphocytes individually, the neutrophil-to-lymphocyte ratio (NLR), and a combined index using all PBLs called Systemic Inflammation Response Index (SIRI). RESULTS All parameters were significant predictors of survival using the previous cutoffs. However, OSCC cutoffs stratified survival outcomes better. Considering neutrophils ≤4.8 × 109 /L as reference, patients with 4.8-9.1 × 109 /L neutrophils had 1.536 times higher risk of death (95% CI, 1.295-1.822), and patients with ≥9.1 × 109 /L had 3.076 times higher risk (95% CI: 2.170-4.360). All PBLs maintained independent prognostic capacity in multivariable analysis. Neutrophils, NLR, and SIRI were significant predictors of survival when validating OSCC cutoffs in the external validation cohort. CONCLUSIONS Pretreatment peripheral blood neutrophils, NLR, and SIRI are the most robust independent predictors of overall survival among all PBLs in OSCC. The authors report externally validated cutoffs that demonstrate the feasibility of including PBLs as host features in the preoperative prognostication of OSCC.

中文翻译：

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预处理的外周血白细胞是口腔癌生存的独立预测因子。

背景技术发炎和免疫监视逃避是癌症的标志。外周血白细胞（PBL）代表两者。本研究的目的是检查PBLs作为口腔鳞状细胞癌（OSCC）结局的预测指标，并找出特定的界限，目的是将PBLs作为患者术前风险评估的宿主因素。方法在1369名OSCC患者的独立队列中检查了先前建立的头颈部鳞状细胞癌（HNSCC）界限。然后，从外部HNSCC队列中的OSCC患者亚组（n = 119）中找到最佳OSCC临界值并进行验证。分析的PBL分别为嗜中性粒细胞，单核细胞和淋巴细胞，嗜中性粒细胞与淋巴细胞之比（NLR），以及使用所有PBL的综合指数，称为系统炎症反应指数（SIRI）。结果所有参数均是先前临界值的重要预测指标。但是，OSCC临界值将生存结局更好地分层。以中性粒细胞≤4.8×109 / L为参考，中性粒细胞4.8-9.1×109 / L的患者死亡风险高1.536倍（95％CI，1.295-1.822），≥9.1×109 / L的患者死亡风险为3.076倍较高的风险（95％CI：2.170-4.360）。在多变量分析中，所有PBL均保持独立的预后能力。在外部验证队列中验证OSCC临界值时，中性粒细胞，NLR和SIRI是生存的重要预测指标。结论预处理的外周血中性粒细胞，NLR和SIRI是OSCC中所有PBL中总生存率最可靠的独立预测因子。