Review Article

Leucocytosis: A Potential Prognosis Biomarker in Head and Neck Malignancies

Neha Sharma^1* and Richa²

¹Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India

²Consultant in Department of Radiation Oncology at Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi

Submission: September 16, 2024; Published: September 25, 2024

*Corresponding Address: Neha Sharma, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana

How to cite this article: Neha Sharma, Richa. Leucocytosis: A Potential Prognosis Biomarker in Head and Neck Malignancies. Canc Therapy & Oncol Int J. 2024; 27(4): 556217. DOI:10.19080/CTOIJ.2024.27.556217

Abstract

Latest research has indicated that inflammation can cause cancer. White blood cell (WBC) count has been linked to a number of malignancies, according to reports, which have demonstrated that overall and disease-free survival of patients with different cancers, including those with head and neck cancer is attributed to leucocytosis. The purpose of this research is to review the most recent information regarding the significance of white blood counts in head and neck malignancies.

Keywords: Leucocytosis in head and neck cancer, raised WBC count in oral cancers, HNSCC, Neutrophil leucocyte ratio

Introduction

Cancer is a group of diseases which develops due to uncontrolled division of cells in any body tissue [1]. There are many factors associated with tumorigenesis like genetic factors, lifestyle factors, infections, inflammation etc. Infection, chronic irritation and inflammation are important components of tumor progression and are major causes for many types of cancer like head and neck cancers [2]. In 2020, about 562,328 people were diagnosed and 277,597 people died with head and neck cancer worldwide [3]. Most of the head and neck cancers, especially oral cancers are derived from precancerous lesions such as leukoplakia, oral submucous fibrosis [4]. Inflammation can result in leucocytosis and presence of leukocytes has been observed in tumor tissue [5]. WBC count has been used as predictor in many cancers [6]. So, WBC count can be a simple and cost effective predictor of head and neck cancers also.

Mechanism

Multiple studies have found a negative correlation between leukocytosis and thrombocytosis and treatment outcomes in patients with head and neck cancer. In head and neck cancer patients, high preoperative neutrophil and lymphocyte ratios are associated with worse disease outcomes, including shorter disease-free survival and overall mortality. It appears that published data offer further useful recommendations for assessing the disease trajectory in individuals with head and neck cancer. Because it responds to a variety of acute and long-term stressors, white blood cell count is very unpredictable. Infection, stress, and long-term irritant exposures like smoking all increase it [7]. Numerous investigations have been carried out for malignancies other than those of the head and neck.

According to Grimm et al. [8], the WBC count was substantially correlated with the probability of dying from cancer. Additionally, WBC count and overall cancer mortality were linked by Erlinger et al. [9]. A correlation between a high WBC count and cancer mortality was also discovered by Shankar et al. [10]. The increased number of neutrophils and monocytes seen in the HNSCC patients are supported by previous reports showing similar findings in other types of cancer [11,12]. The increase could be a result of an increased leukocyte turnover, which could lead to greater inflammation and greater bone marrow-derived immature neutrophil and monocyte infiltration. Therefore, the high neutrophil-lymphocyte ratio found in HNSCC patients points to persistent systemic inflammation [13].

Additionally, a high systemic inflammation may be related to the patient’s prognosis because a high neutrophil-lymphocyte ratio seems to be correlated with a lower survival probability. According to recent findings, this ratio may serve as a prognostic indicator for a number of cancer types [14]. The role of neutrophils in cancer has recently drawn more attention. They are believed to be pro-tumorigenic due to the release of pro angiogenic molecules that promote angiogenesis and the inhibition of the adaptive immune system [15]. Activated neutrophils may induce antitumor activity, according to Gregory and Houghton.

The current data shows that HNSCC patients who have a higher frequency of activated neutrophils live longer, which is evidence in favor of this finding [16]. The increased immune activation that is evident from the high levels of activated T cell subsets and NK cells in HNSCC patients-and particularly in those with confirmed lymph node metastasis-corresponds well with the elevated neutrophillymphocyte ratio. Both show a heightened leukocyte turnover and an accelerated systemic immunological response [17]. NK cells are thought to contribute to tumor immune surveillance and have cytolytic properties [28]. Therefore, it is tempting to assume that the increased number of activated NK cells currently found is a result of improved immune surveillance against the tumor. But it must be remembered that in HNSCC, NK cells have also been linked to diminished anti-tumor activity [18,19].

Discussion

Research on the connection between inflammation and malignancy has been sparked by knowledge of the presence of inflammation in the tumor microenvironment. Inflammation leads to increased TLC which can be used as a predictor for tumor progression and disease outcome. As documented in the table below, many studies have been done to know the correlation between high TLC and head and neck cancers. Most of the studies have resulted in significant connection between TLC and disease outcome except Kruse et.al. which failed to show any correlation between head and neck cancer and TLC levels. Rest of the trials have proved high TLC levels are associated with poorer OS and PFS and also it is a good predictor for progression of PMLs to cancer. High NLR (both preoperative and post treatment)is associated with more aggressive disease and poorer outcomes (Table 1).

Conclusion

Pretreatment leucocytosis is a clinically significant indicator for overall survival and Progression free survival in individuals with locally progressed HNSCC. In head and neck cancer patients, high preoperative neutrophil and lymphocyte ratio ratios are associated with worse disease outcomes, including shorter disease-free survival and overall mortality. Published data appear to offer additional useful recommendations for assessing the course of the disease in patients with head and neck cancer. Further research is warranted to explore treatment avenues that can further explore the relationship between inflammation and aggressiveness in head and neck cancers.

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