title: Prognostic significance of hematological profiles in melanoma patients.
abstract: Cancer-related inflammation may play an important role in disease progression and patient outcome, and could be easily monitored through indirect parameters routinely evaluated at diagnosis. Here, we investigated if peripheral blood cells and the ratios of neutrophils to lymphocytes (NLR) and of lymphocytes to monocytes (LMR) as surrogate markers of cancer related inflammation are associated with disease progression and survival of melanoma patients at any stage of the disease. Records of 1,182 melanoma patients included in an Institutional tumor registry in the period 2000-2010, were reviewed. Among them, 584 patients with a cutaneous or unknown primary melanoma and available pre-operative blood tests were analyzed. Survival was estimated with the Kaplan-Meier method, and analyzed using Log-rank test, Cox regression and multivariate Cox proportional hazard models. We found that patients presenting with distant metastases had higher leukocytes, neutrophils and monocytes, and lower lymphocytes compared to Stage I-III patients. Furthermore, at a single-patient level, hematological profiles changed on disease progression from regional to distant metastatic, with significantly increased circulating leukocytes, neutrophils and monocytes, and decreased lymphocytes. Peripheral blood cell counts were not associated with survival of patients with a localized or regionally metastasized melanoma. Instead, in Stage IV patients, leukocytes (p = 0.001), neutrophils (p = 0.0002), monocytes (p = 0.002), NLR (p < 0.0001) and LMR (p = 0.005) were all significantly associated with survival, independently of other known prognostic factors. These results suggest that cellular components of peripheral blood do count for survival of patients with advanced melanoma.
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gandini
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Ferrucci
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.affiliation: Division of Dermatoncological Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Tosti
authors.affiliation: Division of Pathology, European Institute of Oncology, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Barberis
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pala
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Battaglia
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Clerici
authors.affiliation: Division of Dermatoncological Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spadola
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cocorocchio
authors.affiliation: Medical Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Martinoli
mesh_terms: D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000097:blood* / Q000473:pathology; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries
keywords: NLR; melanoma; monocytes; peripheral blood; prognosis