It has been reported that a high peripheral Tubuloside-A neutrophil level, which was induced by inflammation-related cytokines or tumor-derived myeloid growth factors, may indicate Forsythin systemic inflammation response or a tumor progression. It is because neutrophil can produce proangiogenic factors to assist tumor aggressiveness. The systemic inflammatory response is a non-specific response secondary to tumor hypoxia and necrosis or local tissue damage. There is good evidence that a chronic systemic inflammatory response is clearly related to progressive nutritional decline, a poor response to treatment and poor prognosis in patients with cancer. The acute-phase protein CRP is mainly synthesized and released into the systemic circulation by hepatocytes, and is used as a non-specific marker of inflammation. The magnitude of the increase in CRP levels has been associated with poor survival in cancer, particularly in patients with advanced stage disease. Assessment of the systemic inflammatory response was subsequently refined using a selective combination of hematological components to create inflammation-based prognostic factors. A high neutrophil to lymphocyte ratio has been associated with poor survival in NPC, whereas a high lymphocyte to monocyte ratio has been reported to be a significant predictor of a favorable prognosis in NPC. We believe that nutritional status and the systemic inflammatory response play a major role in the progression and metastasis of NPC. The AGR is a combination of these two predictors of adverse outcome, which may enhance its predictive value. We view the AGR in theory to be a superior predictive factor compared to other indicators of nutrition or inflammation, and suggest that the AGR should be 
assessed prior to treatment in patients with NPC. Nutritional assessment and support, as well as anti-inflammatory therapy, may be suitable treatment choices in NPC, particularly for patients with an AGR,1.4. Currently, there are several ongoing studies investigating the ability of antiinflammatory therapy to prevent and/or treat lung, esophageal, stomach, colon and bladder cancer, and the value of antiinflammatory therapy in NPC needs to be explored further. There are some limitations to the current study. The AGR was calculated indirectly from total serum protein and ALB. Although CRP and other serum proteins are also important indicators of cancer-related inflammation, these factors were not routinely measured at our hospital prior to 2006; therefore, the long-term predictive value of these factors could not be assessed. In addition, the AGR was only assessed at a single time point before treatment. The changes in serum chemistry and complete blood counts over time and in response to treatment, and their relationship with survival are of considerable interest and will be the subject of future work. Despite these limitations, this study is informative. Our findings identify a direct relationship between the pretreatment AGR and long-term mortality in NPC, and suggest that the AGR represents a clinical biomarker which could potentially be modulated to improve patient prognosis. As the AGR is routinely measured at low cost in clinical practice, it has potential as a simple, convenient predictive and stratification factor to assist with clinical decisionmaking in NPC.