Several studies have reported that a high neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes in several cancers, but this ratio has not been thoroughly studied in melanoma except in stage IV. This is the first study on NLR in melanoma stages I-III. This was a retrospective study of 742 melanoma patients. The NLR was classified into NLR<2 and a NLR≥2 on the basis of a receiver operating characteristic curve. Associations of NLR with clinicopathological characteristics and survival were examined. The median patient age was 57 years (range: 15-91; Q1=46, Q3=70), and the median Breslow's thickness was 3.0 mm (range: 0.5-60; Q1=1.0, Q3=7). Clinical stage at presentation was as follows: (i) stage I in 27%; (ii) stage II in 33.2%; (iii) stage III in 36.5%; and (iv) stage IV in 3.3%. NLR≥2 was associated with lymph node metastasis (36.6 vs. 18.1%) and recurrence (28.2 vs. 22.1%). The 5-year overall survival (OS) was 63% for the NLR<2 group and 53% for the NLR≥2 group. Stage-by-stage analysis showed that the 5-year OS in the NLR≥2 group for stages I, II, III, and IV were 91, 60, 28, and 0%, respectively, whereas for the NLR<2 group the 5-year OS were 98, 68, 31, and 0%, respectively. Significant differences between NLR<2 and ≥2 occurred only in stage II (P=0.014). Univariate analysis showed that factors associated with decreased OS clinical stage were Breslow's thickness, ulceration, male sex, and NLR≥2. In the multivariate analysis, all of these factors were predictors of decreased survival. The NLR appears to be an accurate prognostic marker for decreased OS in patients with melanoma, especially in clinical stage II. NLR≥2 correlated with lymph node metastasis and recurrence.

Our patients had worse prognosis compared with data from the US Surveillance, Epidemiology, and End Results database. We found male sex and ALM as independent risk factors for worse survival, in addition to known risk factors.

Background:Several studies have reported that an elevation in neutrophils/lymphocyte ratio (NLR) is correlated with poor survival in patients with colorectal cancer, but in rectal cancer (RC), it has been reported only in a few studies. It is necessary to separate colon cancer and rectal cancer to clarify the prognostic significance of NLR, especially in patients who received chemoradiotherapy.Methods:It is a comparative, observational retrospective study of a cohort of 175 patients. We grouped the patients into two based on their NLR (0-3 vs. > 3) to correlate with disease-specific survival (DSS) and pathologic complete response (pCR).Results:The average NLR was 2.65 + 1.32 (range 0.58-6.89), and 144 (82.3%) patients had an NLR of 0-3. The median follow-up was 33.53 months. There were no differences in pCR between the two groups. The 5-year DSS was 78.8%. NLR did not correlate with survival. Mesorectal quality, pT3-4 tumors, lymph node metastasis, lymphovascular invasion, perineural invasion, positive margins and recurrence were statistically significant predictors of increased mortality in univariate analysis. In multivariate analysis, only overall recurrence correlated with poor survival. The analysis of the association of NLR with outcomes with different cut points (2.0, 2.5, 4 and 5) did not show differences in DSS and pCR.Conclusion:In our cohort, the NLR did not serve as a prognostic marker in patients with locally advanced rectal cancer and who received chemoradiotherapy and did not correlate with pCR as well.

The objective of this study is to determine whether a less exhaustive pathologic work-up to detect melanoma metastasis is clinically useful and does not affect patient prognosis. The success and evolution of the sentinel lymph node (SLN) depends on histological techniques. Several exhaustive protocols of SLN analysis have been published, but are time and cost consuming, with slight increases in the rates of metastasis detection. From 281 patients with SLN biopsy, each SLN was sectioned every 2 mm and from each paraffin block, 2-3 histological sections were evaluated. The patients were divided as follows: the first group (n=185) was subjected to extensive SLN examination (eSLNe) and the second group (n=96) was not subjected to an extensive SLN examination (wSLNe). The average SLN resected was 2 (range: 1-7), evaluating one in 50.9%. The SLN metastasis detection rate was 28.5%, whereas eSLNe increased by 3.2%. During follow-up, 4/26 (17.4%) cases in the wSLNe group showed recurrence in the SLN basin. Factors associated with decreased survival in univariant analysis were recurrence, Breslow thickness, advanced clinical stage, ulceration, and SLN metastasis. eSLNe did not affect disease-specific survival. Multivariate analysis showed recurrence (hazard ratio 23.475, 95% confidence interval: 1903-4559, P<0.001) and Breslow thickness of more than 3.5 mm (hazard ratio 15.222, 95% confidence interval: 1448-3059, P<0.001) as independent risk factors for decreased survival. Our routine for SLN examination enabled an adequate rate of SLN metastasis detection and the eSLNe increased the rate of detection in 3.2%, but did not affect the survival. We did not find any benefit from performing the eSLNe in patients with Breslow thickness less than 3.5 mm.

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