Wednesday, December 26, 2018

Pretreatment NLR levels prognostic in melanoma patients!

As noted in the discussion of adjuvant treatment by melanoma Big Dogs, biomarkers will no doubt come to play an important role in diagnosis and treatment management for melanoma patients.  I've reported on simple, easy to attain and run blood values to provide prognostic and response information for melanoma patients for a looooong time.  Collection of blood for the measurement and comparison of the quantity of white blood cells is just one.  Here are lots of reports:  Prior reports on neutrophils

Now there's this:

Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio in melanoma patients:  A meta-analysisZhan, Ma, Jian.  Clin Chim Acta. 2018 May 20.

Recently, the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) has been widely evaluated in many cancers. Here we assessed the prognostic value of pretreatment NLR in melanoma.  A range of online databases was systematically searched up to March, 2018 for identify available studies which assessed the prognostic significance of NLR. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) were weighted by generic inverse-variance and pooled in random effects meta-analysis.

Twelve studies with 4593 individuals were included. Patients with elevated NLR had a significantly shorter overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS). Subgroup analyses showed that the negative prognostic effect of elevated NLR on OS remained substantial in North American and European populations and patients with non-metastatic and metastatic stage. Additionally, elevated NLR was related to worse OS in patients with melanoma, regardless of the sample size and the cut-off value.

Our findings suggest that elevated pretreatment NLR was associated with poor prognosis in melanoma patients, suggesting NLR might be a prognostic factor in patients with melanoma.

And again...

Neutrophil to lymphocyte ratio is an independent predictor of outcome for patients undergoing definitive resection for stage IV melanoma. Kanatsios, Melanoma Project, Li Wai Suen, et al. J Surg Oncol. 2018 Sep 9.

The aim of this study was to perform a retrospective analysis of survival rates and determine prognostic indicators for patients who underwent definitive surgical resection of stage IV melanoma.
Patients included were those who underwent complete resection of metastatic melanoma. Data was analyzed using IBM SPSS 2.0. Survival estimates were derived from Kaplan-Meier, log-rank, and Breslow tests.
The study population (n = 95) consisted of 60 males and 35 females. Median overall survival (OS) from the first metastasectomy was 49 months (31-67 months). OS at 1, 2, and 5 years was 92%, 87%, and 50% respectively. Predictors of survival included clear surgical margins compared to patients with positive margins (median OS 53 vs 20 months). A preoperative neutrophil to lymphocyte ratio less than 5 experienced a median OS of 65 months compared to 15 months.

This study's results are consistent with previous findings demonstrating favourable long-term outcomes following selective resection of metastatic melanoma. In addition to achieving clear surgical margins, a low preoperative neutrophil to lymphocyte ratio was associated with improved outcomes. These factors may help identify surgical candidates.  (As well as those who may need to more aggressively pursue systemic treatment - adjuvant or other wise. Just my 2 cents!!!)

For what it's worth.  Again. - c

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