Open AccessPrognostic value of H‐index in patients surgically treated for squamous cell carcinoma of the larynx
Author(s) -
BoscoloRizzo Paolo,
Zanelli Enrico,
Giudici Fabiola,
BoscoloNata Francesca,
Cristalli Giovanni,
Deganello Alberto,
Tomasoni Michele,
Piazza Cesare,
Bossi Paolo,
Spinato Giacomo,
Menegaldo Anna,
Emanuelli Enzo,
Nicolai Piero,
Bandolin Luigia,
Ciorba Andrea,
Pelucchi Stefano,
Lupato Valentina,
Giacomarra Vittorio,
Molteni Gabriele,
Marchioni Daniele,
Canzi Pietro,
Mauramati Simone,
Fortunati Alfonso,
Tofanelli Margherita,
Borsetto Daniele,
Fussey Jonathan,
Tirelli Giancarlo
Publication year - 2021
Publication title -
laryngoscope investigative otolaryngology
Language(s) - English
Resource type - Journals
ISSN - 2378-8038
DOI - 10.1002/lio2.603
Subject(s) - medicine , hazard ratio , proportional hazards model , larynx , gastroenterology , stage (stratigraphy) , confidence interval , retrospective cohort study , neutrophil to lymphocyte ratio , oncology , surgery , lymphocyte , paleontology , biology
Objective Recently, a novel host‐related index, the Host‐index (H‐index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host‐related indexes This study aimed to investigate the prognostic performance of the H‐index using pretreatment blood tests in patients receiving up‐front surgery for SCC of the larynx. Methods This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H‐index. Their association with disease‐free survival (DFS) and overall survival (OS) was measured. Results A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37‐96] years; 191 [82.7%] men). The median follow‐up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04‐1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07‐2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21‐3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24‐4.40) and OS (aHR for death = 2.67; 95% CI: 1.51‐4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H‐index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65‐4.79) and death (2.22; 95% CI: 1.26‐3.89). Conclusion In conclusion, the present study confirms the prognostic value of pretreatment H‐index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx. Level of Evidence III