Oral cancer is the world's 11th most prevalent cancer. Diagnosis at the early stage is thus critical for improving patient survival rates. When identified early, the survival probability is roughly 80–90 percent. Therefore, it is critical to assess patients' prognostic variables before surgery. Plasma biomarkers have a great potentiality for predicting tumor recurrence because they can help surgeons make more individualized treatment plans. Furthermore, these markers can be collected through standard blood testing prior to surgery, which is both cost effective and convenient.
Patients with cancer frequently have a better prognosis when there is no inflammation. The detection of circulating cell components is the most common method for measuring the degree of activation of the systemic inflammatory response . For several common peripheral blood-derived inflammation scores, neutrophils play an active role in promoting tumor progression . Conversely, lymphocytes can significantly inhibit the proliferation of tumor . Therefore, the neutrophil-lymphocyte ratio can provide a more reliable tumor prediction effect. Numerous studies have confirmed that NLR is a prognostic factor for a variety of benign and malignant tumors, and as a representative indicator of tumor-associated inflammation, and NLR has been shown to have predictive value for oral cancer[36–39]. Activation of the coagulation cascade has substantial effect in the development of cancer and fibrinogen has been shown to be one of the regulators of systemic inflammation and tumour progression[40, 41]. These studies have laid a solid foundation for the next step to explore the role of inflammatory factors in the prognostic of oral cancer. In this study, patients with advanced tumors tend to have high fibrinogen and NLR levels. In addition, high fibrinogen and high NLR are important indicators for predicting the clinical outcome in this study (P = 0.027 and P = 0.014). The mechanism of action could be as follows: Fibrinogen may function by forming a protective framework that facilitates tumor migration, invasion, and angiogenesis. Tumor cells then create and release fibrinogen, increasing the inflammatory response throughout the body.
The new scoring system (F-NLRs) is a good predictor for prognosis of a variety of malignancies. Wang et al. proved that F-NLRs can independently predict the prognosis of patients with non-small cell lung cancer . Data from Felice's studies showed the F-NLRs is substantially related to worse survival results in individuals with anal canal cancer. The above research has established that the F-NLRs is a reliable scoring system for assessing malignant tumors. There has been no detailed investigation of the application prospects of the F-NLR scoring system in oral cancer. Therefore, the retrospective study was set out to find the F-NLRs associated with prognosis after radical resection of oral cancer.
For predictive analysis following radical excision of oral cancer, we separated the patients with different F-NLRs into three independent groups. The results suggested the F-NLRs, as predicted, can identify more individuals with a worse prognosis than fibrinogen or NLR alone. This demonstrates that F-NLRs may be more reliable than individual scores. In this study, the number of T3-T4 patients with F-NLRs of 0, 1, 2 was 88 (31.42%), 62 (49.6%) and 7 (43.75%) (Table 2). These data show the F-NLRs is connected to tumor development and aggressiveness. The median survival time was 46 months (scores of 0) and 38 months (scores of 1–2), respectively. Patients with the high F-NLRs had a substantially poorer prognosis than those with low score. In our subgroup analyses, the F-NLRs was good prognosis factor, such as in patients with different tumor sizes and lymph node metastases, the F-NLR scoring system has shown a good prognostic effect.
This study has some limitations. Firstly, a single-center retrospective study may lead to selection bias. Secondly, the short follow-up period was not sufficient to further assess the survival of patients. Consequently, a more comprehensive multicenter prospective study is needed to confirm that the F-NLRs does independently predict prognosis in patients with OSCC.
According to the findings of this study, the F-NLRs has clinical promise as a prognostic diagnosis in patients with OSCC. The F-NLRs might be used as a low-cost biomarker to help guide treatment decisions for patients with OSCC.