title: Surgical management of intraabdominal metastases from melanoma: role of the neutrophil to lymphocyte ratio as a potential prognostic factor.
abstract: BACKGROUND
  The aims of this study were to evaluate the role of surgery in the management of patients with intraabdominal metastases from melanoma and to investigate the neutrophil to lymphocyte ratio (NLR) as prognostic factor in this group of patients.
  
  
  METHODS
  Altogether, 44 patients who underwent surgery for Intraabdominal metastases from melanoma with curative, cytoreductive, or palliative intent were analyzed.
  
  
  RESULTS
  There were 77 intraabdominal organ resections performed during the 44 operations. R0 resection was achieved in 19 (43 %) cases. Factors associated with R0 resection were an absence of extra-abdominal metastases, low serum lactate dehydrogenase, involvement of fewer than three sites, and the presence of fewer than three metastatic lesions. The 1-, 3-, and 5-year overall survival rates were, respectively, 79, 66, and 44 % in the curative intent group; 36, 18, and 9 % in the cytoreduction group; and 21, 0 and 0 % in the palliation group (curative intent vs. cytoreduction vs. palliation p < 0.001). By Cox's multivariate analysis, the independent prognostic factors were time from excision of primary melanoma to the diagnosis of intraabdominal metastases, NLR, and residual disease after surgery.
  
  
  CONCLUSIONS
  Our results confirm the usefulness of major surgical interventions as reported in previous studies. We reviewed recent evidence that immunologic phenomena may explain the unexpectedly good response rate in patients with advanced disease. The simple estimation of the NLR has been advocated as a prognostic marker for several cancers. We show that it is likewise useful in metastatic melanoma. We stress the need for developing additional immunologic markers.
authors.affiliation: Department of Surgery, The Royal Marsden, Fulham Road, London, SW3 6JJ, UK, fcm.cananzi@hotmail.it.
authors.forename: Ferdinando C M
authors.initials: FC
authors.lastname: Cananzi
authors.forename: Angus
authors.initials: A
authors.lastname: Dalgleish
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor