Abstract
ObjectivesThe neutrophil–lymphocyte ratio (NLR) is an inflammatory biomarker which is useful in cancer prognostication. We aimed to investigate the differences in baseline NLR between patients with localised and metastatic cutaneous melanoma and how this biomarker changed over time with the recurrence of disease.MethodsThis multicentre cohort study describes patients treated for Stage I–III cutaneous melanoma over 10 years. The baseline NLR was measured immediately prior to surgery and again at the time of discharge or disease recurrence. The odds ratios (OR) for sentinel node involvement are estimated using mixed-effects logistic regression. The risk of recurrence is estimated using multivariable Cox regression.ResultsOverall 1489 individuals were included. The mean baseline NLR was higher in patients with palpable nodal disease compared to those with microscopic nodal or localised disease (2.8 versus 2.4 and 2.3, respectively; p < 0.001). A baseline NLR ≥ 2.3 was associated with 30% higher odds of microscopic metastatic melanoma in the sentinel lymph node [adjusted OR 1.3 (95% CI 1.3, 1.3)]. Following surgery, 253 patients (18.7%) developed recurrent melanoma during surveillance although there was no statistically significant association between the baseline NLR and the risk of recurrence [adjusted HR 0.9 (0.7, 1.1)].ConclusionThe NLR is associated with the volume of melanoma at presentation and may predict occult sentinel lymph metastases. Further prospective work is required to investigate how NLR may be modelled against other clinicopathological variables to predict outcomes and to understand the temporal changes in NLR following surgery for melanoma.
Highlights
The incidence of melanoma has risen faster than any other cancer worldwide [1, 2] and the status of the sentinel lymph node (SLN) is the single most important prognostic factor [3]
The baseline neutrophil–lymphocyte ratio (NLR) was significantly higher in patients with microscopic metastatic melanoma in the SLN compared to those with a negative SLN biopsy, i.e. localised disease only [mean difference 0.1, p = 0.02; Fig. 2]
This study suggests that the neutrophil–lymphocyte ratio (NLR) is proportional to the volume of cutaneous melanoma at presentation
Summary
The incidence of melanoma has risen faster than any other cancer worldwide [1, 2] and the status of the sentinel lymph node (SLN) is the single most important prognostic factor [3]. Only 1 in 5 patients undergoing SLN biopsy yield a node with microscopic deposits [15]. Whilst staging the draining nodal basin remains an important goal, there is a pressing need to improve patient selection and avoid unnecessary SLN biopsies which might be achieved using host biomarkers [19]. For surgically resected BRAF V600-positive Stage III melanoma, adjuvant dabrafenib and trametinib improves survival, discontinuation due to adverse effects is common (25%) [20]. Adjuvant treatment for nonBRAF-mutated tumours improves survival but again, 15% experience drug-related adverse effects and rarely, premature-death [21]. It may be desirable to refine the selection of patients for adjuvant therapy to those at the highest risk of recurrence
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