title: A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study.
abstract: BACKGROUND
  The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date.
  
  
  OBJECTIVE
  We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC.
  
  
  METHODS
  We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC.
  
  
  RESULTS
  Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence.
  
  
  CONCLUSIONS
  Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available.
  
  
  CONCLUSIONS
  A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline.
authors.affiliation: Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Zaragoza
authors.affiliation: Department of Pathology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Kervarrec
authors.affiliation: Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Touzé
authors.affiliation: Dermatology Department, Centre Hospitalier Universitaire Angers, L'Université Nantes Angers Le Mans (LUNAM), Angers, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Avenel-Audran
authors.affiliation: Dermatology Department, Centre Hospitalier Régional Le Mans, Le Mans, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Beneton
authors.affiliation: Dermatology Department, Centre Hospitalier Régional Orléans, Orléans, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Esteve
authors.affiliation: Dermatology Department, Centre Hospitalier Universitaire Poitiers, Poitiers, France.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wierzbicka Hainaut
authors.affiliation: Dermatology Department, Centre Hospitalier Universitaire Besançon, Université de Franche Comté, Equipe d'Accueil 3181, Institut Fédératif de Recherche 133, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Aubin
authors.affiliation: Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Machet
authors.affiliation: Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France; Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France. Electronic address: mahtab.samimi@univ-tours.fr.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Samimi
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D015266:Carcinoma, Merkel Cell / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D009504:Neutrophils; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor
keywords: Merkel cell carcinoma; absolute lymphocyte count; absolute neutrophil count; blood neutrophil-to-lymphocyte ratio; prognostic factor; specific survival