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Systemic Inflammatory Markers as Predictors of Postoperative Complications and Survival in Patients With Advanced Head and Neck Squamous Cell Carcinoma Undergoing Free-Flap Reconstruction

Purpose: The aim of this study was to determine the prognostic value of systemic inflammatory indices as factors for postoperative complications and survival in patients with advanced stages of p16-negative HNSCC undergoing free flap reconstruction. Methods: A retrospective cohort study. The primary predictor variables were inflammatory markers ; neutrophil, lymphocyte, monocyte, and platelet count, neutrophil- lymphocyte (NLR), platelet-lymphocyte (PLR), lymphocyte-monocyte (LMR), derived neutrophil- lymphocyte ratio (dNLR), systemic immune- inflammation (SII) and systemic inflammatory marker index (SIM). Multivariate regression analyses were used to measure the associations between systemic inflammatory indices and overall and disease-free survival as a primary outcome and occurrence of postoperative complications as a secondary outcome measure. Results: The sample was composed of 69 male (76.67 %), and 21 female (23.33%) patients, with an average age of 61.15 ± 9.79 years. The median follow-up time was 24 months and 73 of 91 (66.43%) patients were alive during median follow-up. Overall disease survival correlated with SII (p=0.022, cut-off >1005.3, sensitivity 67.1% and specificity 70.6%) and SIM (p=0.0001, cut-off >4.05, sensitivity 90.4% and specificity 41.2%), preoperative platelets (p=0.036, cut-off <194, sensitivity 28.8% and specificity 94.1%) and postoperative lymphocytes (p=0.012, cut-off <0.6, sensitivity 38% and specificity 76.5%), while increased SIM (p=0.042, cut-off >4.05, sensitivity 91.3% and specificity 38.1%), NLR (p=0.031, cut-off >13.2, sensitivity 56.9% and specificity 60%) and preoperative platelets (p=0.006, cut-off <244, sensitivity 52.3% and specificity 76%) were associated with adverse disease-free survival. The cumulative postoperative complication rate was 34.5%, of which 13.3% accounted for major complications, while dNLR (p=0.013, DF 1, chi-square 6.161, cut- off >2.3) and postoperative lymphocytes (p=0.009, DF 1, chi-square 6.756, cut-off <1) correlated with occurrence of complications. Conclusion. Inflammatory indices as measures of inflammation- related systemic dysfunction may be associated with adverse survival in head and neck squamous cell carcinoma patients and occurrence of postoperative complications and with specific cut- off values.

inflammatory index ; head and neck squamous cell carcinoma ; free flap reconstruction ; prognosis ; outcome ; complications

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