KLİNİK OLARAK EVRE 2 MALİGN MELANOM HASTALARINDA NÖTROFİL VE TROMBOSİT LENFOSİT ORANLARININ SENTİNEL LENF NODU MİKROSKOPİK METASTAZI HAKKINDAKI ÖNGÖRÜ ETKİLERİ

Abstract

Amaç: Yaşamı tehdit eden bir deri kanseri olan malign melanomda hastalığın evresi tedavi yaklaşımını ve sağkalımı etkilemektedir. Malign melanomun evrelemesinde, tümörün mikroskopik olarak ölçülen Breslow kalınlığından, ülserasyondan ve olası bir lenf nodu tutulumundan faydalanılmaktadır. Bu çalışmada sentinel lenf nodu biyopsileri mikroskopik olarak metastazsız (negatif) ve metastazlı (pozitif) olan hastaların nötrofil lenfosit ve trombosit lenfosit oranları karşılaştırıldı ve bu oranların metastaz üzerinde bir öngörü etkisi olup olmadığı değerlendirildi. Gereç ve Yöntem: Ocak 2017–Aralık 2021 tarihleri arasında sentinel lenf nodu biyopsisi ameliyatı yapılmış olan, Breslow kalınlığına göre T değeri T2b veya T3a olan, makroskopik lenf nodu metastazı olmayan (N0) ve sistemik (uzak) metastazı da olmayan (M0) evre 2A malign melanom hastaları çalışmaya dahil edildi. Sentinel lenf nodu biyopsisi durumları ile cinsiyet arasındaki ilişki ve sentinel lenf nodu biyopsisi ile nötrofil ve trombosit lenfosit oranları arasındaki ilişki değerlendirildi. Bulgular: Çalışmaya 65 hasta dahil edildi. Hastaların 24’ü kadın, 41’I erkekti. Hastaların ortalama yaşı 55,58 idi (18–87). Yaş ve cinsiyete göre düzeltme yapmadan ve yapılarak gerçekleştirilen değerlendirmeler sonucunda mikrometastaz açısından nötrofil, lenfosit, platelet sayıları, nötrofil lenfosit oranı (NLO) ve platelet lenfosit oranları (PLO) değerleri bakımından istatistiksel olarak anlamlı fark saptanmadı (p>0,05). Sentinel lenf nodu biyopsisi mikrometastazı olan ve olmayan hastalar arasında cinsiyet bakımından istatistiksel olarak anlamlı fark olduğu saptandı (p=0,009). Mikrometastazlı grupta erkek yüzdesinin mikrometastazsız gruptan daha yüksek olduğu saptandı. Sonuç: Evre 2A malign melanom hastalarında, nötrofil ve trombosit lenfosit oranları, sentinel lenf nodundaki mikroskobik metastazı bağımsız bir değişken olarak öngörememektedir. Bu evredeki erkek hastalarda sentinel lenf nodu mikrometastazı riski kadın hastalara göre daha yüksektir.

Keywords

• Malign melanoma
• mikrometastaz
• nötrofil lenfosit oranı
• sentinel lenf nodu biyopsisi
• trombosit lenfosit oranı

THE PREDICTIVE EFFECT OF NEUTROPHIL AND PLATELET LYMPHOCYTE RATIOS ON MICROSCOPIC SENTINEL LYMPH NODE METASTASES IN STAGE 2 MALIGNANT MELANOMA PATIENTS

Abstract

Objective: Malignant melanoma is a life-threatening disease, and the stage affects both treatment and survival. Staging is based on the microscopic Breslow thickness of the tumor, ulceration, and lymph node status. This study compares the neutrophil and platelet lymphocyte ratios of patients with and without micrometastatic sentinel lymph nodes and assesses the predictive value of these ratios. Materials and Methods: The study includes patients who had a sentinel lymph node biopsy between January 2017 and December 2021 that resulted in a T value of T2b or T3a with neither any regional lymph node metastasis (N0) nor any systemic metastasis (M0). These patients were diagnosed with Stage 2A melanoma. The study evaluates the relationships patients’ sentinel lymph node status and gender have with their neutrophil and platelet lymphocyte ratios. Results: The study includes 65 patients, 24 of who are female and 41 of whom are male. The mean age is 55.58 years (Range = 18 to 87). The neutrophil, lymphocyte, and platelet counts and neutrophil and platelet lymphocyte ratio (NLR and PLR) did not significantly differ between the patients with and those without micrometastasis (p>0.05). The difference showed no significance whether adjusting for age and gender. A significant difference was found between the patients with and those without micrometastasis with respect to gender (p=0.009), with the percentage of males being significantly higher in the patients with micrometastasis. Conclusion: Neutrophil and platelet lymphocyte ratios have not been found to be independent predictors of sentinel lymph node micrometastasis in Stage 2A malignant melanoma, with male patients in this stage having a higher risk of sentinel lymph node micrometastasis.

Keywords

• malignant melanoma
• micrometastasis
• neutrophil lymphocyte ratio
• platelet lymphocyte ratio
• sentinel lymph node biopsy

References

1. Pinto-Paz ME, Cotrina-Concha JM, Benites-Zapata VA. Mortality in cutaneous malignant melanoma and its association with Neutrophil-to-Lymphocyte ratio. Cancer Treat Res Commun 2021;29:100464. google scholar
2. Knackstedt T, Knackstedt RW, Couto R, Gastman B. Malignant melanoma: diagnostic and management update. Plast Reconstr Surg 2018;142(2):202e-16e. google scholar
3. Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther 2018;18(8):775-84. google scholar
4. El Sharouni M-A, Witkamp AJ, Sigurdsson V, van Diest PJ. Trends in sentinel lymph node biopsy enactment for cutaneous melanoma. Ann Surg Oncol 2019;26(5):1494-502. google scholar
5. El Sharouni M-A, Witkamp AJ, Sigurdsson V, van Diest PJ. Probability of sentinel lymph node positivity in melanoma. Eur J Cancer 2019;116:10-2. google scholar
6. Wade RG, Robinson AV, Lo MC, Keeble C, Marples M, Dewar DJ, et al. Baseline neutrophil-lymphocyte and platelet-lymphocyte ratios as biomarkers of survival in cutaneous melanoma: a multicenter cohort study. Ann Surg Oncol 2018;25(11):3341-9. google scholar
7. Robinson AV, Keeble C, Lo MC, Thornton O, Peach H, Moncrieff MD, et al. The neutrophil-lymphocyte ratio and locoregional melanoma: a multicentre cohort study. Cancer Immunol Immunother 2020;69(4):559-68. google scholar
8. Pavri SN, Clune J, Ariyan S, Narayan D. Malignant melanoma: beyond the basics. Plast Reconstr Surg 2016;138(2):330e-40e. google scholar

9. Mancuso F, Lage S, Rasero J, l^az-Ramön JL, Apraiz A, Perez-Yarza G, et al. Serum markers improve current prediction of metastasis development in early-stage melanoma patients: a machine learning-based study. Mol Oncol 2020;14(8):1705-18. google scholar
10. Wade RG, Bailey S, Robinson AV, Lo MC, Peach H, Moncrieff MD, et al. MelRisk: Using neutrophil-to-lymphocyte ratio to improve risk prediction models for metastatic cutaneous melanoma in the sentinel lymph node. J Plast Reconstr Aesthet Surg 2022;75(5):1653-60. google scholar
11. Wang E, Huang H, Tang L, Tian L, Yang L, Wang S, et al. Prognostic significance of platelet lymphocyte ratio in patients with melanoma: A meta-analysis. Medicine (Baltimore) 2021;100(38):e27223. google scholar
12. Pan M, Alavi M, Herrinton LJ. Association of inflammatory markers with disease progression in patients with metastatic melanoma treated with immune checkpoint inhibitors. Perm J 2018;22:17. google scholar
13. Guida M, Bartolomeo N, Quaresmini D, Quaglino P, Madonna G, Pigozzo J, et al. Basal and one-month differed neutrophil, lymphocyte and platelet values and their ratios strongly predict the efficacy of checkpoint inhibitors immunotherapy in patients with advanced BRAF wild-type melanoma. J Transl Med 2022;20(1):1-15. google scholar
14. Cohen JT, Miner TJ, Vezeridis MP. Is the neutrophil-to-lymphocyte ratio a useful prognostic indicator in melanoma patients? Melanoma Manag 2020;7(3):MMT47. google scholar
15. Scoggins CR, Ross MI, Reintgen DS, Noyes RD, Goydos JS, Beitsch PD, et al. Gender-related differences in outcome for melanoma patients. Ann Surg 2006;243(5):693. google scholar
16. Joosse A, De Vries E, Eckel R, Nijsten T, Eggermont AM, Hölzel D, et al. Gender differences in melanoma survival: female patients have a decreased risk of metastasis. J Investigative Dermatol 2011;131(3):719-26. google scholar
17. Mervic L. Time course and pattern of metastasis of cutaneous melanoma differ between men and women. PloS One 2012;7(3):e32955. google scholar