Friday, March 31, 2017

Neutrophil-to-lymphocyte ratios as a predictor of death from melanoma in patients with NONmetastatic disease

I've talked about Neutrophil-to-lymphocyte ratios before as prognostic predictor of a response to ipi/yervoy, noting that having an "....elevated absolute neutrophil counts as well as elevated neutrophil-to-lymphocyte ratios did not bode well for the 720 melanoma patients treated with ipi in this study.  The risk for progression and death was even greater when both of those values were increased.  This report is consistent with the findings from the initial, smaller study of  214 melanoma patients treated with ipi in which:  "Patients with baseline NLR (neutrophil-to-lymphocyte ratio) less than 5, had a significantly improved progression free survival and overall survival compared to those with a NLR equal or greater than 5."

Here's the link to both those reports:  Neutrophils as a prognostic predictor in patients treated with ipi/Yervoy

In this study, from different authors, the NLR is used as a biomarker in folks with NONmetastatic melanoma to predict potential for disease-specific death....

Elevated Blood Neutrophil-to-Lymphocyte Ratio: A Readily Available Biomarker Associated with Death due to Disease in High Risk Nonmetastatic Melanoma. Davis, Langan, Panageas, Postow, et al. Ann Surg Oncol. 2017 Mar 16.

Elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR) is associated with poor oncologic outcomes in patients with stage IV melanoma and other solid tumors, but its impact has not been characterized for patients with high-risk, nonmetastatic melanoma.

Retrospective review of a melanoma database identified patients with high-risk melanoma who underwent operation with curative intent at a single institution. NLR was calculated from blood samples obtained within 2 weeks before operation. Multiple primary melanomas and concurrent hematologic or other metastatic malignancies were excluded. Cumulative incidence of death due to disease was estimated, and Gray's test was used to examine the effect of NLR on melanoma disease-specific death (DOD). Multivariable competing risks regression models assessed associated factors.

Data on 1431 patients with high-risk, nonmetastatic melanoma were analyzed. Median follow-up for survivors was 4 years. High NLR (greater/= to 3 or as continuous variable) was associated with older age, male sex, thicker primaries, higher mitotic index, and more advanced nodal status. On multivariate analysis, high NLR (greater/= to 3 or as a continuous variable), older age, male sex, ulcerated primary, lymphovascular invasion, and positive nodal status were all independently associated with worse DOD.

NLR is a readily available blood test that was independently associated with DOD in patients with high-risk, nonmetastatic melanoma. It is unclear whether high NLR is a passive indicator of poor prognosis or a potential therapeutic target. Further studies to evaluate the prognostic role of NLR to potentially identify those more likely to benefit from adjuvant immunotherapy may prove informative.

If this is so, then following these simple lab values may be super important in whether Stage III peeps should choose adjuvant treatment or not.  - c

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