Authors' reply to Vaish et al.

We are happy to note the keen interest evinced by Vaish et al.[1] in our paper titled, “Exploring the prognostic significance of the pre-treatment inflammatory markers in hypopharyngeal cancers: A retrospective analysis.”[23] The authors have rightly acknowledged the strong biological basis along with the promising preclinical and evolving clinical data pertaining to the association of systemic inflammation with cancer. We also agree that there are several confounding factors in patients with head-and-neck cancers, including medical comorbidities such as chronic obstructive pulmonary disease (COPD), poor orodental hygiene, and superimposed infections, which could potentially interfere with the interpretation of the pretreatment systemic markers of inflammation. It must be noted that the respiratory complications arising due to smoking and the associated COPD are a frequent cause of morbidity and mortality among all patients with cancer and among those with head-and-neck cancers in particular.[4] The heightened susceptibility of such patients in the times of the coronavirus disease 2019 (COVID-19) pandemic has been further highlighted in a recent scoping review.[56] Similarly, poor oral hygiene has also been demonstrated to be an independent risk factor for the development of head-and-neck cancers, and many studies have demonstrated its prognostic significance.[7] The absence of evidence from robust randomized controlled trials and the lack of a universally accepted cutoff value for the pretreatment inflammatory marker ratios are also well acknowledged. However, the correlation between inflammatory markers and cancer has been identified across multiple studies and meta-analyses.[8] Moreover, this correlation has been observed across multiple sites and types of cancers, and our experience of the prognostic implications of the pretreatment inflammatory markers on hypopharyngeal cancers adds to the growing literature. The prognostic implication of systemic markers of inflammation in the management of cancer can no longer be ignored even as we wait for more evidence to unravel. It would be wise for an astute clinician practicing in the community to factor in the low cost and the easy availability of the values of the pretreatment inflammatory markers along with multiple other factors such as the clinical staging, performance status, tobacco use, oral hygiene, and nutritional status among others, prior to decision-making and prognostication of their patients with head-and-neck cancers. The exact association of the above factors with systemic inflammation is yet to be determined. Further, interventions specifically designed to eliminate tobacco and alcohol use, improve oral hygiene, correct malnutrition, and aggressively manage the medical comorbidities will have a positive impact on the survival outcomes of patients with head-and-neck cancers. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract licence: CC BY-NC-SA

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