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Purpose <p>Lymph node metastasis is widely recognized as the most significant prognostic factor in head and neck squamous cell carcinomas (HNSCC). While preoperative imaging techniques have improved, occult metastases often remain undetected, thereby complicating treatment decisions in clinically node-negative (cN0) patients.</p> Methods <p>This retrospective study investigates the predictive value of systemic inflammatory markers—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SIII)—in assessing the risk of occult lymph node metastasis in 76 patients with supraglottic squamous cell carcinoma treated with transoral laser microsurgery and neck dissection. Pre-treatment hematological parameters were analyzed, and receiver operating characteristic (ROC) curves identified optimal cut-off values for each marker.</p> Results <p>Among the 76 cN0 patients, 37 (48.6%) had occult nodal metastases (pN+). NLR exhibited the highest predictive value (Area Under the Curve [AUC] = 0.634), showing a significant association between elevated NLR (&gt; 2.64) and nodal metastases (66.6% vs. 37.0%, <i>p</i> = 0.01). Multivariable logistic regression confirmed NLR as the strongest independent predictor (Odds Ratio [OR] = 5.36; <i>p</i> = 0.004). Elevated SIII and PLR also showed significant associations with nodal metastases and tumor stage, though these were less pronounced. Furthermore, high SIII was linked to reduced overall survival (<i>p</i> = 0.004).</p> Conclusions <p>Although a high NLR indicates an increased metastatic risk, its limited negative predictive value (63%) suggests it is insufficient on its own to guide the decision to forego elective neck dissection (END). Therefore, it cannot independently determine whether an END should be performed. Inflammation-based blood indices, particularly NLR, are accessible and cost-effective tools, but further studies are needed to clarify their role in risk stratification and in personalizing treatment planning for patients with supraglottic carcinoma.</p>

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Preoperative inflammatory ratios as predictors of occult nodal disease in supraglottic carcinoma: implications for transoral laser microsurgery planning

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Luis Juesas-Iglesias,
  • Mario Sánchez-Canteli,
  • Daniel Pedregal Mallo,
  • Juana M. García-Pedrero,
  • Fernando López,
  • Juan P. Rodrigo

摘要

Purpose

Lymph node metastasis is widely recognized as the most significant prognostic factor in head and neck squamous cell carcinomas (HNSCC). While preoperative imaging techniques have improved, occult metastases often remain undetected, thereby complicating treatment decisions in clinically node-negative (cN0) patients.

Methods

This retrospective study investigates the predictive value of systemic inflammatory markers—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SIII)—in assessing the risk of occult lymph node metastasis in 76 patients with supraglottic squamous cell carcinoma treated with transoral laser microsurgery and neck dissection. Pre-treatment hematological parameters were analyzed, and receiver operating characteristic (ROC) curves identified optimal cut-off values for each marker.

Results

Among the 76 cN0 patients, 37 (48.6%) had occult nodal metastases (pN+). NLR exhibited the highest predictive value (Area Under the Curve [AUC] = 0.634), showing a significant association between elevated NLR (> 2.64) and nodal metastases (66.6% vs. 37.0%, p = 0.01). Multivariable logistic regression confirmed NLR as the strongest independent predictor (Odds Ratio [OR] = 5.36; p = 0.004). Elevated SIII and PLR also showed significant associations with nodal metastases and tumor stage, though these were less pronounced. Furthermore, high SIII was linked to reduced overall survival (p = 0.004).

Conclusions

Although a high NLR indicates an increased metastatic risk, its limited negative predictive value (63%) suggests it is insufficient on its own to guide the decision to forego elective neck dissection (END). Therefore, it cannot independently determine whether an END should be performed. Inflammation-based blood indices, particularly NLR, are accessible and cost-effective tools, but further studies are needed to clarify their role in risk stratification and in personalizing treatment planning for patients with supraglottic carcinoma.