ICHNO-ECHNO 2022 - Abstract Book

S91

ICHNO-ECHNO 2022

Department of Health Sciences and Medicine, Biostatistics & Methodology, Lucerne, Switzerland; 4 University of Western Australia, Otolaryngology, Head & Neck Surgery, Medical School, Perth, Australia Purpose or Objective This study investigates the pretherapeutic neutrophil-to-lymphocyte ratio (NLR) with markers of tumor metabolism in 18- fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and their potential prognostic value in head and neck cancer patients prior to primary chemoradiation. Materials and Methods NLR and metabolic markers of primary tumor and nodal metastases including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were retrospectively assessed in a consecutive cohort of head and neck squamous cell cancer patients undergoing primary chemoradiation. The main outcome measure was survival. Results The study included 90 patients of which 74 had lymph node metastases at diagnosis. Median follow-up time of nodal positive patients (n=74) was 26.5 months (IQR 18–44). The NLR correlated significantly with metabolic markers of the primary tumor (TLG: rs=0.47, P <0.001; MTV: rs=0.40, P <0.001; SUVmax: rs=0.34, P =0.003), but much less with FDG-PET/CT surrogate markers of metabolic activity in nodal metastases (TLG: rs=0.15, P =0.19; MTV: rs=0.25, P =0.034; SUVmax: rs=0.06, P =0.63). Conclusion NLR correlates positively with metabolic markers of the primary tumor, suggestive of an unspecific inflammatory response in the host as a possible reflection of increased metabolism of the primary tumor. SUVmax of lymph node metastases and the NLR, however, show no correlation and are independently predictive of disease-specific survival. Therefore, their addition could be used to improve survival prediction in nodal positive head and neck cancer patients undergoing primary chemoradiation. 1 Heinrich Heine University, Düsseldorf University Hospital, Dept. of Radiation Oncology, Düsseldorf, Germany; 2 Heinrich Heine University, Düsseldorf University Hospital, Dept. of Otorhinolaryngology, Düsseldorf, Germany Purpose or Objective Checkpoint inhibitors are shown to be effective in inoperable recurrent or metastatic head and neck cancer (rmHNC), although with a relative low response rate. Finding predictive factors beyond tumor proportion score (TPS) and combined positivity score (CPS) could be the key to improve patient selection. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were reported as predictors of overall survival (OS) in various malignancies. Analysing real world data could also support better understanding of the therapeutic effects in non-trial- population (multimorbid, elderly and frail patients). Materials and Methods 81 patients with rmHNC treated with an inhibitor of programmed cell death protein-1 (PD-1) since 2017 were identified in the electronic clinical records of our head and neck cancer centre. Pre-treatment complete blood count (CBC) results alongside with baseline levels of albumin, haemoglobin, lactate dehydrogenase (LDH) and C-reactive-protein (CRP), CPS, TPS, alcohol consume and smoking habits, body mass index (BMI), Zubrod- (ECOG) and Karnofsky performance scores (KPS) were collected retrospectively. We calculated NLR, MLR, PLR from CBC and modified Glasgow Prognostic Score (mGPS) from serum CRP and albumin levels. Overall survival was estimated with the Kaplan-Meier method, hazard ratios were estimated with uni- and multivariate Cox regression models. All statistical analyses were performed using R version 4.1.1. Results The median follow-up time was 18.2 months. The median OS was 7.8 months (95% confidence interval [CI]: 5.2-13.8 months). There were no significant difference in the hazard ratios of the baseline age subgroups (<60 years, 60-70 years and 70+ years). KPS (above the best cutoff: 80%) was an independent indicator of longer survival (hazard ratio [HR]: 2.9; CI: 1.6-5.5; p < .001). High programmed cell death ligand-1 (PD-L1) expression (CPS, cutoff: 40) was found to be an independent factor (HR: 2.9; CI: 1.1-7.3; p = .027). Smoking history (>10 pack years) was shown an independent negative prognostic factor (HR: 3.3; CI: 1.7-6.5; p < .001). Alcohol consume tendentially worsened outcome, although multivariate not significant. All six investigated inflammatory biomarkers had negative impact on the outcome: low baseline haemoglobin (cutoff: 10 g/dL; HR: 2.9; CI: 1.6-5.1; p < .001), LDH-elevation (cutoff: 247 U/L; HR: 2.2; CI: 1.2-4.1; p = .01), elevated NLR (cutoff: 3; HR: 6.0; CI: 1.5-25.0; p = .013), elevated MLR (cutoff: .6; HR: 2.5; CI: 1.2-5.1; p = .01), elevated PLR (cutoff: 253; HR: 2.3; CI: 1.2-4.6; p = .016) and mGPS > 0 (HR: 2.4; CI: 1.5-3.8; p < .001). Conclusion Present results demonstrate that besides PD-L1-expression, baseline patient performance and smoking history the investigated hematologic and serum biomarkers of inflammation are prognostic factors for patients with rmHNC treated with PD-1-inhibitors. Even elderly patients benefit from checkpoint inhibition therapy. PO-0146 Predictors of outcome beyond PD-L1-expression for recurrent or metastatic head and neck cancer B. Tamaskovics 1 , L. Althaus 2 , J. Haussmann 1 , W. Budach 1 , C. Plettenberg 2