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31.07.2018 | Melanomas | Ausgabe 11/2018 Open Access

Annals of Surgical Oncology 11/2018

Baseline Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratios as Biomarkers of Survival in Cutaneous Melanoma: A Multicenter Cohort Study

Annals of Surgical Oncology > Ausgabe 11/2018
MBBS, DipHR, MClinEd, MRCS, FHEA Ryckie G. Wade, MRes Alyss V. Robinson, BSc(Hons), MBChB, MRCS Michelle C. I. Lo, BSc, MSc, GradStat, PhD Claire Keeble, BM, BCh, MA, FRCP, PhD Maria Marples, BA, MBBS, MRCS(Eng), FRCS(Plast) Donald J. Dewar, MD, FRCS(Plast) Marc D. S. Moncrieff, MBChB, BSc, FRCS(Plast) Howard Peach
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-018-6660-x) contains supplementary material, which is available to authorized users.
Presented at the triennial World Melanoma Congress, Brisbane, Australia, 2017; the Canadian Society of Surgical Oncology Annual Symposium, Vancouver Island, Canada, 2017, winning first-place prize; the British Association of Plastic, Reconstructive and Aesthetic Surgeons Winter Meeting, London, UK, 2017; the International Pigmented Cell International Congress, Denver, CO, USA, 2017; and the European Association of Dermato-Oncology International Congress, Athens, Greece, 2017.



In the peripheral blood, the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) change in response to malignancy. These biomarkers are associated with adverse outcomes in numerous cancers, but the evidence is limited in relation to melanoma. This study sought to investigate the association between these biomarkers and survival in Stages I–III cutaneous melanoma.


This multicenter cohort study investigated a consecutive series of patients who underwent wide excision of biopsy-proven cutaneous melanoma and sentinel lymph node biopsy during a 10-year period. The baseline NLR and PLR were calculated immediately before sentinel lymph node biopsy. Adjusted hazard ratios (HRs) for overall and melanoma-specific survival were generated.


Overall, 1351 patients were included in the study. During surveillance, 184 of these patients died (14%), with 141 of the deaths (77%) attributable to melanoma. Worse overall survival was associated with a baseline NLR lower than 2.5 [HR 2.2; 95% confidence interval (CI) 2.0 to 2.3; p < 0.001] and a baseline PLR lower than 100 (HR 1.8; 95% CI 1.7 to 1.8; p < 0.001). Melanoma-specific survival also was worse, with a baseline NLR lower than 2.5 (HR 1.9; 95% CI 1.6 to 2.2; p < 0.001) and a baseline PLR lower than 100 (HR 1.9; 95% CI 1.7 to 2.2; p < 0.001). The 5-year survival for patients with sentinel lymph node metastases and a low NLR and PLR was approximately 50%.


This study provides important new data on biomarkers in early-stage melanoma, which contrast with biomarker profiles in advanced disease. These biomarkers may represent the host inflammatory response to melanoma and therefore could help select patients for adjuvant therapy and enhanced surveillance.

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