Abstract
Background
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer. Although prognosis is generally favorable, a subset of tumors behaves aggressively. Most established prognostic factors are defined after excision, limiting preoperative risk assessment. The neutrophil-to-lymphocyte ratio (NLR) is an accessible marker of systemic inflammation, but its prognostic value in cSCC remains insufficiently defined.Objective
To evaluate the prognostic utility of preoperative NLR in patients with high-risk cSCC.Methods
We conducted a single-center retrospective cohort study including 420 patients with high-risk cSCC who underwent surgical excision and had a complete blood count within 40 days before surgery. NLR was analyzed continuously and using a ROC-derived cut-off of ≥3. Fine-Gray models addressed competing mortality for cSCC-specific endpoints, whereas Cox regression was used for overall survival (OS).Results
The optimal NLR cut-off for recurrence-free survival (RFS) was 2.97, rounded to 3 (AUC=0.622[0.554-0.690]). NLR≥3 was independently associated with RFS (sHR=2.43[1.62-3.66], P=Limitations
Retrospective single-center design, modest discriminatory ability of NLR alone, and possible residual confounding from unrecorded inflammatory conditions.Conclusion
Preoperative NLR is a low-cost complementary biomarker independently associated with poor outcomes in high-risk cSCC and may complement current risk stratification.