High Neutrophil-to-Lymphocyte Ratio Linked to Poor Survival in Early-Stage Melanoma: Study Suggests

The neutrophil-to-lymphocyte ratio, an easily accessible marker derived from routine blood tests, reflects the balance between the body’s inflammatory and immune responses. In recent years, NLR has emerged as a potential biomarker for predicting outcomes in various cancers, including melanoma. However, the optimal cutoff value for risk stratification in early-stage melanoma patients has remained unclear until now.

To address this, researchers conducted a retrospective observational analysis involving 988 patients diagnosed with localized cutaneous melanoma (stages I and II). Baseline NLR values were obtained, and patients were categorized into two groups based on their NLR levels: ≤4.8 and >4.8. The team then assessed survival outcomes, focusing on melanoma-specific survival and distant metastasis-free survival (DMFS).

The study revealed the following findings:

• Patients with a neutrophil-to-lymphocyte ratio (NLR) above 4.8 had significantly worse clinical outcomes.
• Elevated NLR was associated with more than a threefold increased risk of melanoma-related death (HR 3.2).
• These patients also had twice the likelihood of developing distant metastases (HR 2.0) compared to those with lower NLRs.
• High NLR was more common in male patients and in those with melanomas located on the head or neck.
• Tumors in patients with elevated NLRs frequently showed ulceration and a higher mitotic index (>5 mitoses per mm²), both indicators of aggressive disease.
• Kaplan–Meier survival curves showed clear differences in survival outcomes between high and low NLR groups.
• The findings support NLR as a practical and low-cost prognostic marker for early-stage melanoma.

The authors concluded that an NLR threshold of 4.8 is a valuable indicator to identify patients at higher risk of melanoma progression or mortality, even in the earlier stages of the disease. They emphasized the importance of incorporating NLR evaluation into standard clinical assessments, as it could aid in tailoring more aggressive surveillance or therapeutic strategies for high-risk individuals.

The authors concluded, The study contributes to the growing body of evidence supporting the use of inflammation-based markers like NLR in oncology and highlights the need for further prospective studies to validate these findings in broader patient populations."

Reference:

Ciobotariu, I., Ortega-Berbel, L. A., Calderón-Mollinedo, A., Aguerralde-Martin, M., Requena, C., Moro, R., Manrique-Silva, E., Traves, V., & Nagore, E. 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. International Journal of Dermatology. https://doi.org/10.1111/ijd.17920