Neutrophil-to-lymphocyte Ratio (NLR) as a predictor for recurrence in patients with stage III melanoma

Junjie Ma,Brian Khong,James Kuzman,Abhijit Ray,Si Xuan,Andrew W Hahn,Benjamin O Lawson,Hung T Khong

doi:10.1038/s41598-018-22425-3

Abstract

Neutrophil-to-lymphocyte ratio is a strong predictor for overall survival and disease free survival in many cancers. Our study is the first investigation aiming to determine the predictive value of neutrophil-to-lymphocyte ratio on prognosis of patients with stage III melanoma. This retrospective study utilized a cohort of 107 patients with stage III melanoma treated at Huntsman Cancer Institute, University of Utah, from May 2002 to March 2016. The optimal cutoff of neutrophil-to-lymphocyte ratio was determined by the significance of log-rank tests. A total of 97 log-rank tests were conducted to find the optimal cutoff. Disease free survival was assessed using the Kaplan–Meier method, and univariable and multivariable Cox models were applied to evaluate the predictive value of neutrophil-to-lymphocyte ratio. 2.5 was identified as the optimal cutoff. Kaplan–Meier curve showed that the disease free survival rate of the low value group was significantly higher compared to that of high value group. After adjusting for confounders and other prognostic factors, the neutrophil-to-lymphocyte ratio ≥ 2.5 remained a strong predictor for disease recurrence in patients with stage III melanoma.

Highlights

Melanoma kills an estimated 10,130 people in the United States annually[1]
Prior studies have shown that increased Neutrophil-to-lymphocyte ratio (NLR) is associated with decreased overall survival (OS) and disease free survival (DFS) in melanoma, gastric cancer, breast cancer, lung cancer, and gastrointestinal cancer[4,5,6,7,8,9]
This is the first study to evaluate the predictive value of NLR on melanoma recurrence in patients diagnosed with stage III melanoma

Summary

Introduction

Melanoma kills an estimated 10,130 people in the United States annually[1]. There are five stages of melanoma (Stage 0, Stage I, Stage II, Stage III, and Stage IV). Patients with Stage IIIB (any thickness, with one to three lymph nodes involved and ulceration) have a 5-year survival rate of 59%. Patients with Stage IIIC (defined as one to three macroscopic lymph node metastases and ulcerated primary melanoma) were found to have a 5- year survival rate at 40%2. Central nervous system recurrence of melanoma was found in 4% of stage IIIA and 7% and 13% in stage IIIB and stage IIIC, respectively. Romano et al found the estimate 5-year survivals for stages IIIA, IIIB, and IIIC from time of first relapse were 20%, 20%, and 11%, respectively[3]. Tomita et al found a high preoperative NLR may be a convenient biomarker to identify patients with a poor prognosis after resection for non-small cell lung cancer[7]. A meta-analysis based 144 studies suggested that NLR is a significant prognostic indicator in gastrointestinal cancers[9]

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Conclusion