Prognostic stratification using the Aarhus Composite Biomarker Score in recurrent and metastatic head and neck squamous cell carcinoma.

PURPOSE: Systemic inflammation plays a major role in cancer progression and survival outcomes in head and neck squamous cell carcinoma (HNSCC). This study investigated the prognostic significance of the Aarhus Composite Biomarker Score (ACBS) in recurrent/metastatic HNSCC and compared its performance with established inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR) and advanced lung cancer inflammation index (ALI). METHODS: This retrospective single-center study included patients with recurrent or metastatic HNSCC who received first-line palliative systemic therapy between 2015 and 2025. Baseline inflammatory and nutritional biomarkers were calculated using pretreatment laboratory parameters. Overall survival (OS) was evaluated using Kaplan-Meier and Cox regression analyses. Comparative prognostic performance was assessed using Harrell's concordance index, time-dependent receiver operating characteristic (ROC) analyses, and Akaike Information Criterion (AIC). RESULTS: A total of 54 patients were included. Elevated CRP, neutrophil count, and NLR were associated with inferior OS, whereas higher hemoglobin and ALI values were associated with improved survival. Increasing ACBS category was significantly associated with worse OS (HR: 1.69, 95% CI: 1.16-2.44, p = 0.006). In multivariate analyses including NLR and ALI, ACBS retained borderline prognostic significance (HR: 1.58, 95% CI: 1.00-2.48, p = 0.050), whereas ALI lost significance. ACBS-based models demonstrated better fit than ALI-based models (AIC: 283.3 vs. 288.9). Time-dependent ROC analyses showed similar discrimination between ACBS and NLR (p = 0.953). CONCLUSION: ACBS demonstrated prognostic value in recurrent/metastatic HNSCC and may provide additional prognostic information beyond conventional biomarkers. Given its routine clinical availability, ACBS may represent a practical tool for clinical risk stratification in advanced HNSCC, although external validation is warranted.