Prognostic Value of Neutrophil Percentage-to-Albumin Ratio in Patients with Oral Cavity Cancer

SIMPLE SUMMARY: Inflammatory response and nutritional status play crucial roles in oral cavity squamous cell carcinoma (OSCC). Increasing evidences suggest the prognostic utility of neutrophil percentage-to-albumin ratio (NPAR) in human malignancies. In this study, we enrolled 368 patients with operated OSCC to investigate the prognostic role of NPAR. Our results demonstrated that patients with a high NPAR (≥16.93) had worse overall survival (OS) and disease-free survival (DFS), and a high NPAR (≥16.93) was an independent risk factor for poor OS and DFS in multivariate analyses. The nomogram integrating independent clinicopathological variables and NPAR provides accurate OS prediction and feasible application to OSCC management. Given its high availability and cost-effectiveness, the NPAR has potential to serve as a promising prognostic biomarker in patients with OSCC after external validation in a larger cohort. ABSTRACT: This study investigated preoperative neutrophil percentage-to-albumin ratio (NPAR) for predicting oral cavity squamous cell carcinoma (OSCC) survival. We retrospectively analyzed 368 patients who received curative OSCC surgery between 2008 and 2017. Receiver operating characteristic curve analyses were employed to identify the optimal NPAR cutoff (16.93), and the patients were then separated into low-NPAR and high-NPAR groups. Intergroup differences in survival were determined through Kaplan–Meier analysis and log-rank tests. Disease-free survival (DFS) and overall survival (OS) predictors were identified using Cox proportional-hazards models. A nomogram integrating independent prognostic factors was proposed to increase the accuracy of OS prediction. A high NPAR (≥16.93) was associated with worse median OS and DFS than was a low NPAR (both p < 0.001); this finding was confirmed through multivariate analyses (hazard ratio (HR) for OS = 2.697, p < 0.001; and HR for DFS = 1.671, p = 0.008). The nomogram’s favorable predictive ability was confirmed by the calibration plots and concordance index (0.784). The preoperative NPAR is thus a promising prognostic biomarker in patients with OSCC after external validation in a larger cohort. Our nomogram can facilitate clinical use of the NPAR and provides accurate individualized OS predictions.