Stage-Dependent Elevation of Platelet-Based Inflammatory Indices in Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study

Pritanjali Singh; Dharmendra Singh

doi:10.31557/APJCC.2026.11.5.727

Authors

Pritanjali Singh Department of Radiotherapy, All India Institute of Medical Sciences, Patna, India.
Dharmendra Singh Department of Radiotherapy, All India Institute of Medical Sciences, Patna, India. https://orcid.org/0000-0001-8962-890X

DOI:

https://doi.org/10.31557/APJCC.2026.11.5.727

Keywords:

Platelet-to-lymphocyte ratio, Platelet-to-neutrophil ratio, Platelet-to-eosinophil ratio, Systemic inflammation, Head and neck squamous cell carcinoma, Cancer prognosis

Abstract

Introduction: To evaluate baseline hematological characteristics and stage-wise variation of platelet-based inflammatory indices, platelet lymphocyte ratio (PLR), platelet neutrophil ratio (PNR), and platelet eosinophil ratio (PER) in patients with head and neck squamous cell carcinoma (HNSCC), and to examine their association with disease stage.

Materials and Methods: This retrospective observational study included 831 treatment-naïve HNSCC patients treated between January 2022 and December 2025. Hematological parameters were obtained from baseline complete blood counts, and PLR, PNR, and PER were calculated. As data were non-normally distributed (Shapiro–Wilk test, p < 0.001), results are reported as median (interquartile range), and comparisons across stages were performed using the Kruskal–Wallis test with Dunn’s post hoc analysis. Multivariable logistic regression was used to assess independent associations adjusting for age, gender, tobacco use, and tumor site.

Results: Inflammatory indices demonstrated right-skewed distributions, with median PLR, PNR, and PER of 162.3, 48.7, and 1078.4, respectively. All indices showed significant stage-wise increases (p < 0.001). ROC analysis revealed that PLR had the highest discriminative ability for advanced disease (AUC: 0.741; 95% CI 0.701-0.781), followed by PER (AUC: 0.651; 95% CI 0.613-0.699) and PNR (AUC: 0.635; 95% CI 0.585- 0.686). On univariate analysis, PLR, PNR, PER, tobacco use, and tumor site were significantly associated with stage. However, on multivariable regression, only PLR (adjusted OR: 1.013, p < 0.001) and tumor site remained independently associated with advanced-stage disease.

Conclusion: Platelet-based inflammatory indices demonstrate significant associations with disease stage in HNSCC. These findings likely reflect underlying systemic inflammatory changes associated with tumor burden; however, their prognostic or predictive utility requires validation in prospective studies with survival outcomes.