Next Article in Journal
The Intraoperative Utility of Raman Spectroscopy for Neurosurgical Oncology
Previous Article in Journal
Health-Related Quality of Life in the Era of Immune Checkpoint Blockade: What Do Patient-Reported Outcomes Reveal?
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Cancers
Volume 17
Issue 24
10.3390/cancers17243919
cancers-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
Comment of Cancers 2021, 13(16), 4166.
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Comment

Comment on Kumarasamy et al. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166

by
Dimitris Tatsis
1,
Alexandros Louizakis
1,* and
Angeliki Cheva
2
1
Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
2
Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(24), 3919; https://doi.org/10.3390/cancers17243919
Submission received: 27 August 2025 / Revised: 2 December 2025 / Accepted: 4 December 2025 / Published: 8 December 2025
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Review Reports Versions Notes
Exploring minimally invasive prognostic markers in head and neck squamous cell carcinoma is of value. To be robust and applicable research must adhere to strict inclusion criteria. This 2021 study on the prognostic utility of platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), and monocyte–lymphocyte ratio (MLR) in head and neck cancers (HNCs), however, included esophageal, gastric, and thyroid cancers in HNCs [1]. These should not be grouped with HNCs, nor should lip cancers. Esophageal cancers often encompass both SCC and adenocarcinoma; Barrett’s esophagus and gastroesophageal reflux disease (GERD) are precursors for adenocarcinoma [2,3,4]. Gastric adenocarcinomas are influenced by Helicobacter pylori infection [5,6]. Thyroid carcinomas are also obviously different. The inclusion of studies on esophageal and gastric cancers in a meta-analysis aimed at elucidating HNC prognostic markers, introduces unwarranted unrelated heterogeneity. This is compounded by the study’s reported high between-study heterogeneity (e.g., I2 > 50% in pooled analyses), which may obscure conclusions about the prognostic relevance of PLR, NLR, and MLR [6].
Peripheral blood inflammatory biomarkers (PLR, NLR, MLR) may provide prognostic utility in HNCs. NLR had the highest accuracy (81%) in detecting occult neck metastases in early-stage oral cavity carcinomas (OCCs), but MLR lacks statistical significance (p = 0.73) [7]. Elevated NLR was reported as a negative prognostic factor in 40 cases of head and neck squamous cell carcinoma (SCC) [8].
Among HNCs, there should be distinction among EBV+ nasopharyngeal carcinoma, HPV+ oropharyngeal carcinoma, and non-virus-related SCC (e.g., in oral cavity and larynx). That these tumors are anatomically nearby is not a reason to group them together.
We strongly advocate for more focused investigations to delineate the role of these markers.

Conflicts of Interest

The authors declare no conflicts of interest. All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

References

  1. Kumarasamy, C.; Tiwary, V.; Sunil, K.; Suresh, D.; Shetty, S.; Muthukaliannan, G.K.; Baxi, S.; Jayaraj, R. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166. [Google Scholar] [CrossRef] [PubMed]
  2. Hernandez-Prera, J.C.; Riddle, N.; Gonzalez, R.S.; Asa, S.L. Endocrine and Neuroendocrine Tumors. Arch. Pathol. Lab. Med. 2025, 149, 1114–1135. [Google Scholar] [CrossRef] [PubMed]
  3. Barsouk, A.; Aluru, J.S.; Rawla, P.; Saginala, K.; Barsouk, A. Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma. Med. Sci. 2023, 11, 42. [Google Scholar] [CrossRef] [PubMed]
  4. Farsi, N.J.; Rousseau, M.-C.; Schlecht, N.; Castonguay, G.; Allison, P.; Félix Nguyen-Tan, P.; Soulieres, D.; Coutlée, F.; Hier, M.; Madathil, S.; et al. Aetiological Heterogeneity of Head and Neck Squamous Cell Carcinomas: The Role of Human Papillomavirus Infections, Smoking, and Alcohol. Carcinogenesis 2017, 38, 1188–1195. [Google Scholar] [CrossRef] [PubMed]
  5. Smith, E.M.; Rubenstein, L.M.; Haugen, T.H.; Hamsikova, E.; Turek, L.P. Tobacco and Alcohol Use Increases the Risk of Both HPV-Associated and HPV-Independent Head and Neck Cancers. Cancer Causes Control 2010, 21, 1369–1378. [Google Scholar] [CrossRef] [PubMed]
  6. Troise, S.; Di Blasi, F.; Esposito, M.; Togo, G.; Pacella, D.; Merola, R.; Di Crescenzo, R.M.; Staibano, S.; Abbate, V.; Bonavolontà, P.; et al. The Role of Blood Inflammatory Biomarkers and Perineural and Lympho-Vascular Invasion to Detect Occult Neck Lymph Node Metastases in Early-Stage (T1-T2/N0) Oral Cavity Carcinomas. Cancers 2025, 17, 1305. [Google Scholar] [CrossRef] [PubMed]
  7. Thrift, A.P. Global Burden and Epidemiology of Barrett Oesophagus and Oesophageal Cancer. Nat. Rev. Gastroenterol. Hepatol. 2021, 18, 432–443. [Google Scholar] [CrossRef] [PubMed]
  8. Beydoun, A.S.; Stabenau, K.A.; Altman, K.W.; Johnston, N. Cancer Risk in Barrett’s Esophagus: A Clinical Review. Int. J. Mol. Sci. 2023, 24, 6018. [Google Scholar] [CrossRef] [PubMed]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Tatsis, D.; Louizakis, A.; Cheva, A. Comment on Kumarasamy et al. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166. Cancers 2025, 17, 3919. https://doi.org/10.3390/cancers17243919

AMA Style

Tatsis D, Louizakis A, Cheva A. Comment on Kumarasamy et al. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166. Cancers. 2025; 17(24):3919. https://doi.org/10.3390/cancers17243919

Chicago/Turabian Style

Tatsis, Dimitris, Alexandros Louizakis, and Angeliki Cheva. 2025. "Comment on Kumarasamy et al. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166" Cancers 17, no. 24: 3919. https://doi.org/10.3390/cancers17243919

APA Style

Tatsis, D., Louizakis, A., & Cheva, A. (2025). Comment on Kumarasamy et al. Prognostic Utility of Platelet–Lymphocyte Ratio, Neutrophil–Lymphocyte Ratio and Monocyte–Lymphocyte Ratio in Head and Neck Cancers: A Detailed PRISMA Compliant Systematic Review and Meta-Analysis. Cancers 2021, 13, 4166. Cancers, 17(24), 3919. https://doi.org/10.3390/cancers17243919

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop