Integration of neutrophil to high-density lipoprotein ratio for prognostic assessment of nasopharyngeal carcinoma: a large-scale long-term retrospective study

Background: Recent research suggests that the emerging neutrophil to high-density lipoprotein ratio (NHR) has a significant correlation with the survival outcomes across a range of tumors. However, its prognostic value in nasopharyngeal carcinoma (NPC) remained to be elucidated. This study aimed to evaluate the relationship between NHR and overall survival (OS) in patients with NPC, as well as to develop a corresponding prognostic model. Methods: We conducted a retrospective analysis of 834 NPC patients who received platinum-based concurrent chemoradiotherapy (CCRT) between January 2010 and December 2014. The optimal NHR cutoff was determined using maximally selected rank statistics. Survival analyses were performed using Kaplan-Meier methods and Cox regression models. A prognostic nomogram incorporating NHR with conventional risk factors was developed and validated. Results: The NHR score successfully segregated NPC patients into two categories with significantly different OS (HR = 0.672, 95% CI: 0.481-0.939, P = 0.019). Multivariate analysis confirmed NHR as an independent prognostic factor, along with age, T stage, and N stage. Considering EBV-DNA is a well-established prognostic factor for NPC in accordance with clinical practice and previous studies, we incorporated it together with the above factors to construct the prognostic nomogram. The established nomogram showed modestly higher predictive accuracy (C-index = 0.696, 95% CI: 0.654-0.738) compared to conventional staging parameters (C-index = 0.648, 95% CI: 0.583-0.713). Conclusion: Pre-treatment NHR serves as an independent prognostic indicator for survival in NPC patients undergoing CCRT. This readily available, cost-effective biomarker, when integrated with traditional prognostic factors, provides a comprehensive tool for risk stratification and treatment planning. External validation through multicenter studies is warranted to confirm these findings.