Neutrophil to apolipoprotein A‐I ratio as an independent indicator of locally advanced nasopharyngeal carcinoma

PURPOSE: To explore the peripheral blood cells (neutrophil/monocyte/lymphocyte/platelet) to apolipoprotein AI or high‐density lipoprotein‐cholesterol ratio (NAR, MAR, LAR, PAR, NHR, MHR, LHR, and PHR) as independent prognostic indicators for stage III nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: Between 2009 and 2014, 562 patients diagnosed with stage III NPC who were treated with a concomitant chemotherapy and intensity‐modulated radiotherapy with cumulative cisplatin dose ≥200 mg/m(2) were included in this retrospective study. Routine blood and biochemical variables and baseline clinical characteristics (T and N stage, age, sex, and induction chemotherapy) were collected. After inserting 19 hematological parameters into a set, we applied the least absolute shrinkage and selection operator (LASSO) algorithm and restricted cubic splines regression to select valuable parameters for predicting 5‐year overall survival (OS). Subsequently, univariate and multivariate survival analyses were used to assess independent indicators of 5‐year OS, distant metastasis survival, regional recurrence‐free survival (RRFS), and disease‐free survival. RESULTS: NAR, MAR, serum lactated dehydrogenase (LDH), and Epstein‐Barr virus (EBV)‐DNA were selected using LASSO regression, and the optimal cut‐off values for NAR, MAR, EBV‐DNA, and, LDH were 4.39, 0.3, 1590 copies/mL, and 218.4 IU/L, respectively. In multivariate survival analysis, higher NAR was associated with both poor 5‐year OS and RRFS (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.09‐3.25, P = .024; HR, 3.13; 95% CI, 1.42‐6.91, P = .005, respectively). CONCLUSION: NAR could be an attractive indicator for evaluating the 5‐year OS in patients with stage III NPC, which is closely related to inflammation and circulating lipid metabolism. Level of Evidence: 4