N. Paez Arango1, P. Philips1, C. R. Scoggins1, A. R. Quillo1, R. C. Martin1, K. M. McMasters1, M. E. Egger1 1University Of Louisville,Hiram C. Polk, Jr., MD Department Of Surgery,Louisville, KY, USA
Introduction:
An elevated neutrophil-to-lymphocyte ratio (NLR) has been reported to be a significant prognostic factor for several solid organ malignancies. The significance of the NLR has not been well studied in cutaneous melanoma. In this study the value of the NLR as a predictor of lymph node metastasis and survival in cutaneous melanoma was assessed.
Methods:
A retrospective review of patients who underwent either a sentinel lymph node (SLN) biopsy or complete lymph node dissection (CLND) between 2002 to 2017 at a single academic referral center was performed. The NLR was determined by reviewing preoperative complete blood counts drawn within 30 days prior to the procedure. Differences in the NLR according to SLN and non-SLN status were evaluated by Wilcoxon rank sum tests. The predictive ability of NLR to determine SLN and non-SLN status was evaluated with NLR as continuous variable in logistic regression models and using cut points according to the NLR distribution. Survival was compared using Kaplan-Meier survival curves and the log rank test.
Results:
In this study, 162 patients underwent sentinel lymph node (SLN) biopsy, and 46 (28.4%) had a positive SLN biopsy. The median NLR for the patients with negative SLN was 2.2 compared to 2.1 for those who had a positive SLN (P=0.6). There were 23 patients who underwent a CLND, and 8 (35%) had a positive non-SLN. The median NLR for patients with a negative CLND (non-SLN negative) was 1.6 versus 2.6 for those with a positive non-SLN (p=0.6). When measured as a continuous variable, NLR did not predict a positive SLN (odds ratio 1.08, 95% CI 0.93 – 1.26), nor did it predict a positive non-SLN in patients undergoing CLND (odds ratio 1.41, 95% CI 0.78 – 2.56). Using a cutoff of 2, there was no significant difference in the rate of positive SLN for patients with a NLR <2 (27%) vs NLR >= 2 (30%, p = 0.68). There was no significant difference in the rate of positive non-SLN for patients undergoing CLND with a NLR < 2 (25%) vs NLR >=2 (45%, p = 0.40). There was no statistically significant difference in overall survival for patients undergoing SLN biopsy with NLR >= 2 compared to < 2 (Figure 1).
Conclusion:
In this study pre-procedure NLR does not predict SLN or non-SLN metastases in cutaneous melanoma. NLR does not predict survival differences in patients staged with SLN biopsy for cutaneous melanoma.
