Neutrophil-to-Lymphocyte Ratio Associated With Worse Melanoma Specific-Survival and Distant Metastasis Free Survival in Localized (Stage I and II) Cutaneous Melanoma: An Observational Retrospective Study on 988 Patients.

Abstract

Introduction: The neutrophil-to-lymphocyte ratio (NLR) is a critical biomarker of the immune system that plays an important role in predicting the outcome of various malignant tumors, including skin cancer. This study aimed to evaluate an NLR cutoff that could help better predict the prognosis of patients with localized melanoma.

Materials and methods: We designed a retrospective, longitudinal, observational study of 988 patients with localized melanoma for whom NLR levels were collected at baseline. To evaluate the prognostic value of NLR, the patients were divided into two groups: > 4.8 vs. ≤ 4.8. We analyzed the association between increased NLR levels and clinical and pathological variables using Pearson's chi-squared test and Fisher's exact test. Univariate and multivariate Cox proportional hazards models were built using stepwise backward selection to evaluate the association between NLR values and melanoma-specific survival (MSS); NLR values and distant metastasis-free survival (DMFS). Kaplan-Meier survival curves were used to illustrate the difference in survival outcomes between the two groups.

Results: An NLR level of > 4.8 was associated with male sex, melanoma located on the head or neck, a mitotic index of > 5 mitoses/mm², ulceration, worse MSS (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.8-5.9; p < 0.001) and a higher probability of developing distant metastasis (HR 2.0, 95% CI 1.1-3.7; p = 0.034).

Conclusions: We identified an NLR level of 4.8 as the best cutoff to distinguish patients with localized melanoma (stages I and II) who are at an increased risk of death due to melanoma (MSS) and of developing distant metastasis (DMFS).