C. T. Mayemura1, G. Gauvin1, K. Ruth3, K. Liang1, E. McGillivray1, K. Loo1, A. Olszanski2, S. Movva2, W. H. Ward1, B. Luo5, H. Wu4, S. Reddy1, J. Farma1 1Fox Chase Cancer Center,Surgical Oncology,Philadelphia, PA, USA 2Fox Chase Cancer Center,Department Of Hematology/Oncology,Philadelphia, PA, USA 3Fox Chase Cancer Center,Department Of Biostatistics,Philadelphia, PA, USA 4Fox Chase Cancer Center,Department Of Pathology,Philadelphia, PA, USA 5Fox Chase Cancer Center,Molecular Diagnostics Laboratory,Philadelphia, PA, USA
Introduction: While pathology reports provide many prognostic markers for melanoma patients, the utilization of serum complete blood count (CBC) values are less established. Recent studies have shown that platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have predictive value for other cancers. The goal of this study was to explore the association between platelet, lymphocyte and monocyte-derived ratios and the recurrence and survival in stage II and III melanoma patients.
Methods: Using data from a prospectively maintained database at our NCI designated cancer center, patients diagnosed with a stage II or III melanoma between 2005 and 2017 were reviewed. Patients who underwent surgery and had preoperative CBC data available were included for analysis. PLR and LMR values were split into quartile variables to compare overall survival (OS) and cumulative incidence of recurrence or cause-specific mortality using log rank and Gray’s tests. Competing risk regression methods were used to adjust for age, adjuvant therapy and pathological stage in multivariable models.
Results: A total of 313 patients (57% male) were included, with a median age of 66 (range 21-99). Pathological stage included IIA (N=77), IIB (N=64), IIC (N=33), IIIA (n=42), IIIB (N=63), and IIIC (34). In the follow-up period 78 patients died; of those alive, median follow-up was 27.4 months. Adjuvant therapy was given to 45 patients (14%); treatments included interferon (n=23), PD-1 or CTLA-4 inhibitors (n=21), or chemotherapy (n=1). LMR (range 0.5-22.8) was separated by quartiles, with cutoff values of 2.3, 3.2 and 4.0. Similarly, PLR (range 22.7 – 1406) quartiles had cutoff values of 109.0, 135.3 and 176.2. Patients in the 4th quartile PLR had a significantly higher rate of recurrence or death due to melanoma (Figure 1) (p=0.01), with a cumulative incidence of melanoma recurrence or death at 3-years of 0.54 compared to probabilities of 0.40, 0.25, and 0.33 for quartiles 1-3. When using competing risk regression to adjust for age, adjuvant therapy and pathological stage, this same cohort showed higher incidence of recurrence (subHR=1.79, 95% CI=1.05-3.04, p=0.031).
Conclusion: In looking at preoperative CBC values, we found that PLR values were independently associated with melanoma recurrence or death for stage II and III melanoma patients, while LMR values held less predictive value. We look forward to evaluating this finding in a larger cohort.
