Clinicopathological Features of Patients with Malignant Melanoma Diagnosis and Prognostic and Predictive Importance of Neuthrophil-Lymphocyte Ratio

Öz

In this study, the effect of demographic, laboratory and clinicopathological parameters along with neutrophil-lymphocyte ratio (NLR) on prognosis and survival and correlation with other parameters was researched in patients with malignant melanoma (MM) diagnosis. In our study, 107 patients monitored for MM diagnosis in Eskişehir Osmangazi University Medical Oncology clinic from 2010-2017 were retrospectively assessed. Age, gender, LDH level, pathological parameters, BRAF mutation status, neutrophil-lymphocyte ratio (NLR) and the effects of these parameters on overall survival (OS) and disease-free survival (DFS) and correlations with each other were researched. At time of diagnosis, 86% of patients were in the early stage. The dominant types identified were cutaneous MM and nodular MM. Median NLR cut-off value was identified as 1.97. All non-cutaneous MM cases were BRAF negative (p<0.0001). High NLR was associated with advanced stage (p=0.001), advanced age (p=0.008), ulceration presence (p=0.011), and high mitosis count (p=0.05). High NLR (p<0.0001), high LDH level (p=0.04), increased Breslow thickness (p=0.01), increased Clark level (p=0.01), high mitosis count (p=0.02), and lymph node (LN) involvement (p=0.04) were correlated with significantly shorter OS durations. Cox multivariate regression analysis identified the most effective independent parameters on OS were LN involvement (HR: 3.4, p=0.01) and high NLR (HR: 4.6, p=0.04). Nodal involvement was also identified as the most predictive independent parameter for recurrence (HR: 3.2, p=0.03). In addition to classic parameters, NLR appears to be a biomarker which can predict prognosis. Patients with nodal involvement and high NLR values should be monitored more closely in clinics. Data require support with broad-scale studies.

Anahtar Kelimeler

• malignant melanoma
• NLR
• prognostic factors

Malign Melanom Tanılı Hastalarda Klinikopatolojik Özellikler Ve Nötrofil-Lenfosit Oranının Prognostik Ve Prediktif Önemi

Öz

Bu çalışmada MM tanılı hastalarda demografik, labaratuvar özellikler ve klinikopatolojik parametrelerle birlikte nötrofil-lenfosit oranının (NLR) prognoz ve sağkalım üzerine etkisi ve diğer parametrelerle ilişkisi araştırıldı. Çalışmamızda 2010-2017 yılları arasında Eskişehir Osmangazi Üniversitesi Tıbbi Onkoloji Kliniği’nde takip edilen MM tanılı 107 hasta retrospektif olarak değerlendirildi. Yaş, cinsiyet, LDH seviyesi, patolojik parametreler, BRAF mutasyon durumu, nötrofil-lenfosit oranı(NLR) ile bu parametrelerin genel sağkalım(OS) ve hastalıksız sağkalım(DFS) üzerine etkisi ve birbirleri ile ilişkisi araştırıldı. Hastaların tanı anında %86’sı erken evredeydi. Kutanöz MM ve nodüler malign melanom (NMM), ağırlıklı saptanan tipti. Medyan NLR cut-off değeri 1.97 saptandı. Non-kutanöz MM olgularının hepsi BRAF negatifti (p<0.0001). Yüksek NLR ileri evre (p=0.001), ileri yaş (p=0.008), ülserasyon varlığı (p=0.011), yüksek mitoz sayısı (p=0.05) ile ilişkiliydi. Yüksek NLR (p<0.0001), yüksek LDH seviyesi (p=0.04), artmış Breslow kalınlığı (p=0.01), artmış Clark düzeyi (p=0.01), yüksek mitoz sayısı (p=0.02), LN (Lenf nodu) tutulumu (p=0.04) anlamlı olarak daha kısa OS süreleri ile ilişkiliydi. Cox çok değişkenli regresyon analizlerinde OS üzerinde en etkili bağımsız değişken parametreler LN tutulumu (HR:3.4 p=0.01) ve yüksek NLR (HR:4.6 p=0.04) olarak saptandı. Nodal tutulum ayrıca nüksü en çok predikte eden bağımsız parametre olarak saptandı (HR:3.2 p=0.03). Klasik parametreler yanında NLR de prognozu öngördürebilecek bir biyobelirteç gibi görünmektedir. Nodal tutulumu olan ve NLR değeri yüksek olan hastalar klinikte daha yakından takip edilmelidir. Verilerin geniş çaplı çalışmalarla desteklenmesine ihtiyaç vardır.

Anahtar Kelimeler

• malignant melanoma
• NLR
• prognostic factors

Kaynakça

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