title: Elevated Blood Neutrophil-to-Lymphocyte Ratio: A Readily Available Biomarker Associated with Death due to Disease in High Risk Nonmetastatic Melanoma.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Data on 1431 patients with high-risk, nonmetastatic melanoma were analyzed. Median follow-up for survivors was 4 years. High NLR (≥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 (≥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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Davis
authors.affiliation: Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Panageas
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Melanoma and Immunotherapeutics Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Postow
authors.affiliation: Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Brady
authors.affiliation: Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ariyan
authors.affiliation: Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. coitd@mskcc.org.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000097:blood / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D015415:Biomarkers