Comparison of Platelet-Lymphocyte Ratio Before and After Chemotherapy in Nasopharyngeal Carcinoma Based on Histopathology

Article History

Submited : November 29, 2021
Published : March 30, 2022

Introduction: Nasopharyngeal carcinoma (NPC) is a non-lymphomatous squamous cell carcinoma in the nasopharyngeal epithelial layer which can be classified into three categories with different prognosis based on histopathological examination. This study aimed to compare platelet-lymphocyte ratio (PLR) in NPC patients before and after chemotherapy based on histopathological type. Method: this cohort study recorded data from medical records. The histopathological type, chemotherapy regimen, clinical stage, and PLR of NPC patients were recorded and compared before and after therapy using paired T-test and Wilcoxon test. The prognostic strength of PLR and the value of the cut-off point was determined by looking at the Area Under Curve (AUC) value using the Receiver Operating Characteristic (ROC) curve method. Results: A total of 44 NPC patients received chemotherapy for three cycles, including 21 patients with NPC type-2 and 23 patients with NPC type-3. There were significant differences in the average PLR before and after undergoing three cycles of chemotherapy in type III NPC (p=0.023). At the same time, there were no statistically significant differences in type-II NPC (p=0.131). The prognostic ability of pre-chemotherapy PLR in assessing disease progression in type II NPC was good (AUC=0.763) with 100.0% sensitivity and 73.68% specificity. In type III NPC, the prognostic ability of PLR was very good (AUC 0.881) with 100% sensitivity value and 76.19% specificity. Conclusion: A significant PLR decrease was obtained after the 3rd cycle of chemotherapy in type III NPC following brexel-cisplatin regimen but not in type II NPC. This is probably due to the use of a cisplatin therapy regimen that is more responsive to type III NPC. In addition, examining PLR value before undergoing chemotherapy can be a predictor in assessing disease progression in type III NPC patients.


  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
  2. Colevas AD, Yom SS, Pfister DG, Spencer S, Adelstein D, Adkins D, et al. NCCN guidelines ® insights: Head and neck cancers, version 1.2018 featured updates to the NCCN guidelines. JNCCN Journal of the National Comprehensive Cancer Network. 2018;16(5):479–490.
  3. Santoso BS, Surarso B, Kentjono WA, Kepala B. Radiotherapy in Nasopharyngeal Carcinoma. THT KL. 2009;2(3):134-41.
  4. Petersson F. Nasopharyngeal carcinoma: A review. Seminars in Diagnostic Pathology. 2015;32(1):54–73.
  5. Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B, Gondhowiardjo S, et al. Nasopharyngeal carcinoma in indonesia: Epidemiology, incidence, signs, and symptoms at presentation. Chin J Cancer. 2012;31(4):185–196.
  6. Cen RX, Li YG, Li Y. Platelet-to-lymphocyte ratio as a potential prognostic factor in nasopharyngeal carcinoma: A meta-analysis. Medicine (United States). 2019;98(38). doi:10.1097/MD.0000000000017176.
  7. Liew KY, Zulkiflee AB. Neutrophil–lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma. Braz J Otorhinolaryngol. 2018;84(6):764–771.
  8. Yang S, Zhao K, Ding X, Jiang H, Lu H. Prognostic significance of hematological markers for patients with nasopharyngeal carcinoma: A meta-analysis. J Cancer. 2019;10(11):2568–2577.
  9. Ye L, Oei RW, Kong F, Xu T, Shen C, Wang X, et al. Prognostic values of hematological biomarkers in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Eur Arch Oto-Rhino-Laryngology. 2018;275(5):1309–1317.
  10. Akutanto IA, Indrasari SR. Relationship between Neutrophil-to-lymphocyte ratio with clinical stadium of nasopharygneal carcinoma patients. Yogyakarta: Gadjah Mada University; 2015.
  11. Hasibuan NR, Farhat F, Haryuna TSH, Yudhistira A. Korelasi positif ekspresi cyclooxygenase-2 dengan microvessel density pada karsinoma nasofaring. Oto Rhino Laryngol Indones. 2014;44(1):34.
  12. Pan XX, Liu YJ, Yang W, Chen YF, Tang WB, Li CR. Histological subtype remains a prognostic factor for survival in nasopharyngeal carcinoma patients. Laryngoscope. 2020;130(3):E83–E88.
  13. Sharif SET, Zawawi N, Yajid AI, Shukri NM, Mohamad I. Pathology classification of nasopharyngeal carcinoma. In: An Evidence-Based Approach to the Management of Nasopharyngeal Cancer. 2020. Elsevier: 73–92.
  14. Chen JH, Huang WY, Ho CL, Chao TY, Lee JC. Evaluation of oral tegafur-uracil as metronomic therapy following concurrent chemoradiotherapy in patients with non-distant metastatic TNM stage IV nasopharyngeal carcinoma. Head Neck. 2019;41(11):3775–3782.
  15. Chen YP, Chen C, Mai ZY, Gao J, Shen LJ, Zhao BC, et al. Pretreatment platelet count as a predictor for survival and distant metastasis in nasopharyngeal carcinoma patients. Oncol Lett. 2015;9(3):1458–1466.
  16. Eggemann H, Ehricke J, Ignatov T, Fettke F, Semczuk A, Costa SD, et al. Platelet count after chemotherapy is a predictor for outcome for ovarian cancer patients. Cancer Invest. 2015;33(5):193–196.
  17. Gay LJ, Felding-Habermann B. Contribution of platelets to tumour metastasis. Nature Reviews Cancer. 2011;11(2):123–134.
  18. Jiang R, Zou X, Hu W, Fan YY, Yan Y, Zhang MX, et al. The elevated pretreatment platelet-to-lymphocyte ratio predicts poor outcome in nasopharyngeal carcinoma patients. Tumor Biol. 2015;36(10):7775–7787.
  19. Liao Q, Guo X, Li X, Li X, Chen P, Liang F, et al. Analysis of the contribution of nasopharyngeal epithelial cancer cells to the induction of a local inXammatory response. J Cancer Res Clin Oncol. 2012;138(1):57–64.
  20. Ruuskanen M, Grenman R, Leivo I, Vahlberg T, Mäkitie A, Saarilahti K, et al. Outcome of nasopharyngeal carcinoma in Finland: A nationwide study. Acta Oncol (Madr). 2018;57(2):251–256.
  21. Barrett‐Lee P, Bokemeyer C, Gascón P, Nortier JWR, Schneider M, Schrijvers D, et al. Management of Cancer‐Related Anemia in Patients with Breast or Gynecologic Cancer: New Insights Based on Results from the European Cancer Anemia Survey. Oncologist. 2005;10(9):743–757.
  22. Zulkarnain I, Surarso B, Purnami N. Penurunan hemoglobin, neutrofil, dan trombosit pascakemoterapi cisplatin-paclitaxel pada penderita tumor ganas kepala dan leher. Jurnal THT. 2017;10(1):1–10.
  23. Noviyani R, Indrayathi PA, Budiana ING, Niruri R, Tunas K, Adnyani NMDD. Effect of paclitaxel-cisplatin chemotherapy towards hemoglobin, platelet, and leukocyte levels in epithelial ovarian cancer patients. J Appl Pharm Sci. 2019;9(1):104–107.
  24. Bardash Y, Olson C, Herman W, Khaymovich J, Costantino P, Tham T. Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis. Oncology Research and Treatment. 2019;42(12):665–676.
  25. Lippitz BE. Cytokine patterns in patients with cancer: A systematic review. The Lancet Oncology. 2013;14(6):e218–e228.
  26. Chen KJ, Zhou L, Xie HY, Ahmed TE, Feng XW, Zheng S Sen. Intratumoral regulatory T cells alone or in combination with cytotoxic T cells predict prognosis of hepatocellular carcinoma after resection. Med Oncol. 2012;29(3):1817–1826.
  27. Bastid J, Bonnefoy N, Eliaou JF, Bensussan A. Lymphocyte-derived interleukin-17A adds another brick in the wall of inflammation-induced breast carcinogenesis. OncoImmunology. 2014;3(3). doi:10.4161/onci.28273.
  28. Wu S-G, Lian C-L, Wang J, Zhang W-W, Sun J-Y, Lin Q, et al. The effect of histological subtypes on survival outcome in nasopharyngeal carcinoma after extensive follow up. Ann Transl Med. 2019;7(23):768–768.
Aksmitayani, A., Kadir, A., Perkasa, M. F., & Punagi, A. Q. (2022). Comparison of Platelet-Lymphocyte Ratio Before and After Chemotherapy in Nasopharyngeal Carcinoma Based on Histopathology. Nusantara Medical Science Journal, 7(1), 1-11.


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