A nomogram with the peripheral blood neutrophil-to-lymphocyte ratio before treatment predicts the survival of patients with nasopharyngeal carcinoma

Abstract

Background: This study was performed to investigate the relationship of the pretreatment neutrophil count and neutrophil-to-lymphocyte ratio (NLR) with the prognosis of nasopharyngeal carcinoma (NPC), as well as to establish an NLR-related nomogram to predict survival in patients with NPC. Methods: In total, 747 patients with NPC were enrolled between January 2005 and January 2015 at our hospital. Kaplan–Meier survival analysis was used to evaluate overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS), with comparisons made using the log-rank test. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors for OS, PFS, and DMFS. The optimal NLR cut-off value was determined using receiver operating characteristic curve analysis. A nomogram model was then constructed and validated using R software (Version 3.6.0). Results: Among the 747 patients, N stage (P = 0.01, 0.042, 0.017) and NLR (P = 0.037) were identified as independent predictors of DMFS. Independent predictors of OS were sex (P = 0.024), age (P = 0.019), N stage (P = 0.006, 0.031, 0.002), American Joint Committee on Cancer (AJCC) stage (P = 0.003), adjuvant chemotherapy (P = 0.016), and NLR (P = 0.036). N stage (P = 0.001, 0.0221, 0.003), AJCC stage (P = 0.001), and NLR (P = 0.035) were also associated with PFS. The prognostic model showed good agreement with actual outcomes. Compared with the TNM staging system, the nomogram demonstrated superior accuracy and stability. Conclusions: In patients with NPC, an elevated pretreatment NLR was associated with poorer OS, PFS, and DMFS. The NLR-based nomogram provided more accurate survival prediction than clinical staging and may serve as a valuable tool in guiding prognosis and treatment planning.