Distant metastasis in oral squamous cell carcinoma: Does the neutrophil-to-lymphocyte ratio act as a surrogate of the host immune status?

OBJECTIVES: Distant metastasis (DM) is an important prognostic factor for oral squamous cell carcinoma (OSCC). The aim of this study is to evaluate the influence of host and tumor factors in development of DM. MATERIALS AND METHODS: After IRB approval, 1369 patients with OSCC undergoing primary surgery were eligible for the study. The primary endpoint was the development of distant metastasis (DM). Patients were pathologically staged according to the American Joint Committee on Cancer, 8(th) Edition. Pre-operative peripheral blood counts were used to calculate neutrophil-to-lymphocyte ratio (NLR). RESULTS: Median follow-up was 39 months (range 1–221). DM were identified in 126 patients during follow-up. When analyzed as a time-dependent covariate, neck recurrence (NR) was a significant predictor of DM (HR 16.35, 95% CI: 11.39–23.47, p