{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:33:33Z","timestamp":1760236413376,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T00:00:00Z","timestamp":1637280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Many patients with adenoid-cystic carcinoma (ACC) experience an indolent course of disease over many years but face late recurrence, and long-term survivors are rare. Due to its infrequent occurrence, it is hard to predict outcome in these patients. The fibrinogen-to-lymphocyte ratio (FLR) was recently proposed as an outcome prognosticator in different cancer entities. We aimed to investigate its prognostic relevance in patients with head and neck ACC. This retrospective analysis was performed including all patients treated for ACC between 1998 and 2020. The FLR ratio was calculated based on pretreatment values (0\u20137 days). The study cohort was dichotomized based on optimized threshold value and compared for differences in outcome (overall survival (OS) and disease-free survival (DFS)). In the cohort of 39 included patients, the OS was significantly longer in the low (n = 28) compared to the high pretreatment FLR group (n = 11) (median OS 150.5 months, 95% confidence intervals (CI) 85.3\u2013215.7 months vs. 29.4 months, 95% CI not reached; p = 0.0093). Similarly, the DFS was significantly longer in the low FLR group (median DFS 74.5 months, 95% CI 30.6\u2013118.4 months vs. 11.0 months, 95% CI 5.1\u201316.9 months; p = 0.019). The FLR is an easily obtainable and simple marker and may be a valuable outcome prognosticator in patients with ACC. Further studies are needed for validation of our results.<\/jats:p>","DOI":"10.3390\/jpm11111228","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T02:43:09Z","timestamp":1637289789000},"page":"1228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Potential Prognostic Value of a Novel Hematologic Marker Fibrinogen-to-Lymphocyte Ratio in Head and Neck Adenoid-Cystic Carcinoma"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0770-6677","authenticated-orcid":false,"given":"Faris F.","family":"Brkic","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3293-867X","authenticated-orcid":false,"given":"Stefan","family":"Stoiber","sequence":"additional","affiliation":[{"name":"Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlene","family":"Friedl","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregor","family":"Heiduschka","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenz","family":"Kadletz-Wanke","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hellquist, H., and Skalova, A. (2014). Histopathology of the Salivary Glands, Chapter 8: Adenoid Cystic Carcinoma, Springer.","DOI":"10.1007\/978-3-540-46915-5"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.oraloncology.2006.01.001","article-title":"Salivary gland adenoid cystic carcinoma: A review of chemotherapy and molecular therapies","volume":"42","author":"Dodd","year":"2006","journal-title":"Oral Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00020840-200404000-00013","article-title":"Adenoid cystic carcinoma of the head and neck: A review","volume":"12","author":"Bradley","year":"2004","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.oraloncology.2015.04.005","article-title":"Adenoid cystic carcinoma of the head and neck\u2014An update","volume":"51","author":"Rodrigo","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/MOO.0000000000000347","article-title":"Adenoid cystic carcinoma evaluation and management: Progress with optimism!","volume":"25","author":"Bradley","year":"2017","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1054\/ijom.2003.0448","article-title":"Adenoid cystic carcinoma of the head and neck\u2014A 20 years experience","volume":"33","author":"Kokemueller","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yu, Y., Wang, H., Yan, A., Wang, H., Li, X., Liu, J., and Li, W. (2018). Pretreatment neutrophil to lymphocyte ratio in determining the prognosis of head and neck cancer: A meta-analysis. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4230-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2830","DOI":"10.1002\/hed.26329","article-title":"Neutrophil-to-lymphocyte ratio as a prognostic indicator for overall and cancer-specific survival in squamous cell carcinoma of the head and neck","volume":"42","author":"Ferrandino","year":"2020","journal-title":"Head Neck"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1002\/hed.25324","article-title":"Neutrophil-to-lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta-analysis","volume":"40","author":"Tham","year":"2018","journal-title":"Head Neck"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/jop.12832","article-title":"Prognostic role of platelet-to-lymphocyte ratio in oral cancer: A meta-analysis","volume":"50","author":"Zhang","year":"2021","journal-title":"J. Oral Pathol. Med."},{"key":"ref_11","first-page":"1435","article-title":"Prognostic value of pretreatment cardiovascular biomarkers in head and neck squamous cell carcinoma","volume":"27","author":"Thebit","year":"2020","journal-title":"Oral Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.oooo.2018.10.009","article-title":"Pretreatment assessment of hematologic and inflammatory markers in adenoid cystic carcinoma: Neutrophil\/lymphocyte ratio is associated with multiple recurrences","volume":"127","author":"Brkic","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e16974","DOI":"10.1097\/MD.0000000000016974","article-title":"Prognostic value of pretreatment plasma fibrinogen in patients with colorectal cancer: A systematic review and meta-analysis","volume":"98","author":"Li","year":"2019","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e993","DOI":"10.6061\/clinics\/2020\/e993","article-title":"Pretreatment plasma fibrinogen level as a prognostic biomarker for patients with lung cancer","volume":"75","author":"Zhang","year":"2020","journal-title":"Clinics"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Feng, F., Zheng, G., Wang, Q., Liu, S., Liu, Z., Xu, G., Wang, F., Guo, M., Lian, X., and Zhang, H. (2018). Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. BMC Gastroenterol., 18.","DOI":"10.1186\/s12876-018-0877-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4719","DOI":"10.2147\/CMAR.S204938","article-title":"A novel preoperative plasma indicator to predict prognoses for patients with esophageal squamous cell carcinoma after radical esophagectomy: Fibrinogen-to-lymphocyte ratio","volume":"11","author":"Fan","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.3389\/fonc.2019.01159","article-title":"Clinical Significance of Serum CA125, CA19-9, CA72-4, and Fibrinogen-to-Lymphocyte Ratio in Gastric Cancer With Peritoneal Dissemination","volume":"9","author":"Huang","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4921","DOI":"10.2147\/CMAR.S308659","article-title":"Elevated Pretreatment Fibrinogen-to-Lymphocyte Percentage Ratio Predict Tumor Staging and Poor Survival in Non-Small Cell Lung Cancer Patients with Chemotherapy or Surgery Combined with Chemotherapy","volume":"13","author":"Liu","year":"2021","journal-title":"Cancer Manag. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature07205","article-title":"Cancer-related inflammation","volume":"454","author":"Mantovani","year":"2008","journal-title":"Nature"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S1470-2045(01)00619-2","article-title":"Cancer and the prothrombotic state","volume":"3","author":"Lip","year":"2002","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1010428317700002","DOI":"10.1177\/1010428317700002","article-title":"Plasma fibrinogen level may be a possible marker for the clinical response and prognosis of patients with breast cancer receiving neoadjuvant chemotherapy","volume":"39","author":"Mei","year":"2017","journal-title":"Tumour Biol."},{"key":"ref_22","first-page":"457","article-title":"High Fibrinogen and Platelets Correlate with Poor Survival in Gastric Cancer Patients","volume":"50","author":"Zhang","year":"2020","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ijsu.2019.03.022","article-title":"Clinicopathological and prognostic significance of preoperative plasma fibrinogen level in patients with upper urinary tract urothelial carcinoma: A retrospective tumor marker prognostic study","volume":"65","author":"Liu","year":"2019","journal-title":"Int. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1158\/1541-7786.MCR-19-1033","article-title":"Fibrinogen Alpha Chain Knockout Promotes Tumor Growth and Metastasis through Integrin-AKT Signaling Pathway in Lung Cancer","volume":"18","author":"Wang","year":"2020","journal-title":"Mol. Cancer Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/jso.21668","article-title":"High preoperative plasma fibrinogen levels are associated with distant metastases and impaired prognosis after curative resection in patients with colorectal cancer","volume":"102","author":"Tang","year":"2010","journal-title":"J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1007\/s12282-020-01067-2","article-title":"High absolute lymphocyte counts are associated with longer overall survival in patients with metastatic breast cancer treated with eribulin-but not with treatment of physician\u2019s choice-in the EMBRACE study","volume":"27","author":"Miyoshi","year":"2020","journal-title":"Breast Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.3748\/wjg.v21.i9.2668","article-title":"Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer","volume":"21","author":"Eo","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1111\/odi.13049","article-title":"Preoperative circulating platelet, neutrophil, and lymphocyte counts predict survival in oral cancer","volume":"25","author":"Diao","year":"2019","journal-title":"Oral Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1177\/0194599816659257","article-title":"Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy","volume":"155","author":"Damar","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_30","first-page":"34","article-title":"Adenoid cystic carcinoma of head and neck. A 5-year retrospective study: Experience in a single third-level reference center","volume":"88","year":"2020","journal-title":"Cir Cir"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/s12070-018-1442-0","article-title":"Evaluation of Multimodality Management of Adenoid Cystic Carcinoma of the Head and Neck","volume":"71","author":"Bahl","year":"2019","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.oooo.2015.10.003","article-title":"Adenoid cystic carcinoma of the minor salivary glands: A retrospective series of 29 cases and review of the literature","volume":"121","author":"Shum","year":"2016","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1228\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:32:32Z","timestamp":1760167952000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/11\/1228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,19]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jpm11111228"],"URL":"https:\/\/doi.org\/10.3390\/jpm11111228","relation":{},"ISSN":["2075-4426"],"issn-type":[{"type":"electronic","value":"2075-4426"}],"subject":[],"published":{"date-parts":[[2021,11,19]]}}}