Preoperative neutrophil-to-lymphocyte ratio and recurrence in high-risk cutaneous squamous cell carcinoma

Design

Single-centre retrospective cohort with Fine-Gray and Cox models

Population

420 patients with excised high-risk cutaneous squamous cell carcinoma

Primary outcome

Recurrence-free and overall survival by preoperative neutrophil-to-lymphocyte ratio

Effect

Ratio 3 or more: recurrence-free survival sub-HR 2.43 (95% CI 1.62 to 3.66); overall survival HR 1.49 (1.14 to 1.94)

A single-centre retrospective cohort of 420 patients with high-risk cutaneous squamous cell carcinoma, all excised and with a blood count within 40 days before surgery, tested the neutrophil-to-lymphocyte ratio as a prognostic marker.

The best cut-off was about 3. A ratio of 3 or more was independently associated with recurrence-free survival (sub-hazard ratio 2.43, 95% CI 1.62 to 3.66) and overall survival (hazard ratio 1.49, 1.14 to 1.94), and with other cancer-specific outcomes. Discrimination was modest (AUC 0.622, 0.554 to 0.690).

The authors acknowledge the retrospective single-centre design and possible confounding from unrecorded inflammatory conditions. The cut-off was derived from the same data it was tested in, which tends to overstate performance. The ratio comes from a routine blood count, but it should not drive management by itself.

• A ratio of 3 or more went with a higher recurrence risk (sub-hazard ratio 2.43).
• Discrimination was modest (AUC 0.62), so it cannot sort patients alone.
• The cut-off was chosen in the same cohort, so it needs external validation.
• Concurrent infection or inflammation can raise the ratio.
• Use it, if at all, as one of several risk features alongside histology and staging.

Why it matters

It offers a free preoperative signal where most prognostic factors are only known after excision.

Don't overread it

A retrospective, single-centre study with a cut-off derived in the same cohort shows an association, not a validated decision tool.

The statistics, in plain English

An AUC of 0.62 is only a little better than a coin toss (0.5) at separating patients who recur from those who do not. A hazard ratio can be real and still leave the marker poor at predicting for an individual.

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