151751-Najiba-Chargi

132 CHAPTER 7 Figure 3. Kaplan Meier Survival curves for OS for early stage HNSCC patients according to SMM and NLR status shows significant differences in overall survival between patients with low SMM compared to patients without low SMM, especially in those patients with combined low SMM and elevated NLR, (Log rank χ 2= 10.2, p=0.02). Kaplan Meier Survival curves for overall survival of advanced stage HNSCC patients according to SMM and NLR status shows no significant differences in survival (Log rank χ 2= 3.0, p=0.4). DISCUSSION This study showed that low SMM and elevated NLR have significant predictive impact for postoperative complications and LOS and prognostic impact for survival in (subgroups of) patients undergoingmicrovascular free flap head and neck reconstruction. Prognostic impact of these biomarkers was however only seen in patients with early stage HNSCC. It is possible that TNM stage itself is a strong prognostic factor in advanced stage HNSCC and therefore no prognostic impact was seen for SMM and NLR. For advanced stage HNSCC, hemoglobin had significant (but low) prognostic impact for OS. This finding is in accordance with previous lit - erature, which shows that the relative risk of death increased by 75% in anemic patients with head and neck cancer. 34 Also in patients who underwent surgery and adjuvant radiotherapy for locally advanced HNSCC, low hemoglobin appears to be an important prognostic factor. 35