Sentinel lymph node status versus tumor characteristics, neutrophil to lymphocyte ratio, C-reactive protein levels and C-reactive protein to albumin ratio-prognostic factors for primary cutaneus melanoma
Journal
European Journal of Nuclear Medicine and Molecular Imaging
Date Issued
2019-09-18
Author(s)
DOI
10.1007/s00259-019-04486-2
Abstract
Aim/Introduction: The aim of this study was to identify tumor
characteristics of primary malignant melanoma, neutrophil to
lymphocyte ratio (NLR), C - reactive protein (CRP) levels and
C - reactive protein to albumin ratio (CRP/Alb) predictive of
sentinel lymph node (SLN) positive status and their impact on
disease recurrence, melanoma specific survival (MSS), disease
free survival (DFS) and overall survival (OS) period. Materials
and Methods: 100 patients with primary malignant melanoma,
clinically staged T1b/T2+ (1-4mm thick) N0, M0 underwent SLN
detection procedure. Tumor characteristics, NLR, CRP levels and
CRP/Alb ratio were analyzed in correlation with SLN status. The
optimal cutoff values of NLR and CRP/Alb were determined by
the receive operative characteristics (ROC) analysis. Univariate
and multivariate Cox regression analyses, t - test for continuous or
X2 test for categorical variables and Kaplan-Meier curve analyses
were performed to assess factors predicting SLN positive status,
regional recurrence rate, DFS, MSS and OS period. Results:
We identified Breslow`s thickness (OR=1,51; 95% CI 1,02-
2,01; p=0,034), presence of ulceration (p=0,041), lymphocytic
infiltration (OR=0,42; 95% CI 0,18-0,99; p=0,02), high mitotic
rate (p=0,031), high Ki67 index (p<0,01), high NLR (HR=2,45;
95% CI 1,52-3,34; p<0,01), increased CRP levels (HR=1,53; 95%
CI 1,33-1,75; p<0,001) and high CRP/Alb ratio (HR=2,01; 95% CI
1,15-3,52; p=0,016) as independent predictors of SLN positive
status. SLN status was the strongest predictor (HR=0,241; 95%
CI 0,45-1,01; p=0,04) of DFS, MSS and OS period. Conclusion:
We confirmed Breslow’s thickness, presence of ulceration,
lymphocytic infiltration extent, high mitotic rate, high Ki67
index, high NLR, increased CRP levels and high CRP/Alb ratio
as factors predictive of SLN metastatic involvement. We also
confirmed SLN status to be the most significant independent
predictor of DFS, MSS, OS and risk of regional recurrence. Key
words: neutrophil to lymphocyte ratio, c - reactive protein to
albumin ratio, prognostic factors, melanoma, sentinel lymph
node
characteristics of primary malignant melanoma, neutrophil to
lymphocyte ratio (NLR), C - reactive protein (CRP) levels and
C - reactive protein to albumin ratio (CRP/Alb) predictive of
sentinel lymph node (SLN) positive status and their impact on
disease recurrence, melanoma specific survival (MSS), disease
free survival (DFS) and overall survival (OS) period. Materials
and Methods: 100 patients with primary malignant melanoma,
clinically staged T1b/T2+ (1-4mm thick) N0, M0 underwent SLN
detection procedure. Tumor characteristics, NLR, CRP levels and
CRP/Alb ratio were analyzed in correlation with SLN status. The
optimal cutoff values of NLR and CRP/Alb were determined by
the receive operative characteristics (ROC) analysis. Univariate
and multivariate Cox regression analyses, t - test for continuous or
X2 test for categorical variables and Kaplan-Meier curve analyses
were performed to assess factors predicting SLN positive status,
regional recurrence rate, DFS, MSS and OS period. Results:
We identified Breslow`s thickness (OR=1,51; 95% CI 1,02-
2,01; p=0,034), presence of ulceration (p=0,041), lymphocytic
infiltration (OR=0,42; 95% CI 0,18-0,99; p=0,02), high mitotic
rate (p=0,031), high Ki67 index (p<0,01), high NLR (HR=2,45;
95% CI 1,52-3,34; p<0,01), increased CRP levels (HR=1,53; 95%
CI 1,33-1,75; p<0,001) and high CRP/Alb ratio (HR=2,01; 95% CI
1,15-3,52; p=0,016) as independent predictors of SLN positive
status. SLN status was the strongest predictor (HR=0,241; 95%
CI 0,45-1,01; p=0,04) of DFS, MSS and OS period. Conclusion:
We confirmed Breslow’s thickness, presence of ulceration,
lymphocytic infiltration extent, high mitotic rate, high Ki67
index, high NLR, increased CRP levels and high CRP/Alb ratio
as factors predictive of SLN metastatic involvement. We also
confirmed SLN status to be the most significant independent
predictor of DFS, MSS, OS and risk of regional recurrence. Key
words: neutrophil to lymphocyte ratio, c - reactive protein to
albumin ratio, prognostic factors, melanoma, sentinel lymph
node