Surgical management of intraabdominal metastases from melanoma: Role of the neutrophil to lymphocyte ratio as a potential prognostic factor

Ferdinando C M Cananzi, Angus Dalgleish, Satvinder Mudan

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19 Citations (Scopus)

Abstract

Background: The aims of this study were to evaluate the role of surgery in the management of patients with intraabdominal metastases from melanoma and to investigate the neutrophil to lymphocyte ratio (NLR) as prognostic factor in this group of patients. Methods: Altogether, 44 patients who underwent surgery for Intraabdominal metastases from melanoma with curative, cytoreductive, or palliative intent were analyzed. Results: There were 77 intraabdominal organ resections performed during the 44 operations. R0 resection was achieved in 19 (43 %) cases. Factors associated with R0 resection were an absence of extra-abdominal metastases, low serum lactate dehydrogenase, involvement of fewer than three sites, and the presence of fewer than three metastatic lesions. The 1-, 3-, and 5-year overall survival rates were, respectively, 79, 66, and 44 % in the curative intent group; 36, 18, and 9 % in the cytoreduction group; and 21, 0 and 0 % in the palliation group (curative intent vs. cytoreduction vs. palliation p <0.001). By Cox's multivariate analysis, the independent prognostic factors were time from excision of primary melanoma to the diagnosis of intraabdominal metastases, NLR, and residual disease after surgery. Conclusions: Our results confirm the usefulness of major surgical interventions as reported in previous studies. We reviewed recent evidence that immunologic phenomena may explain the unexpectedly good response rate in patients with advanced disease. The simple estimation of the NLR has been advocated as a prognostic marker for several cancers. We show that it is likewise useful in metastatic melanoma. We stress the need for developing additional immunologic markers.

Original languageEnglish
Pages (from-to)1542-1550
Number of pages9
JournalWorld Journal of Surgery
Volume38
Issue number6
DOIs
Publication statusPublished - 2014

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Melanoma
Neutrophils
Lymphocytes
Neoplasm Metastasis
L-Lactate Dehydrogenase
Multivariate Analysis
Survival Rate
Biomarkers
Serum
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Surgical management of intraabdominal metastases from melanoma : Role of the neutrophil to lymphocyte ratio as a potential prognostic factor. / Cananzi, Ferdinando C M; Dalgleish, Angus; Mudan, Satvinder.

In: World Journal of Surgery, Vol. 38, No. 6, 2014, p. 1542-1550.

Research output: Contribution to journalArticle

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abstract = "Background: The aims of this study were to evaluate the role of surgery in the management of patients with intraabdominal metastases from melanoma and to investigate the neutrophil to lymphocyte ratio (NLR) as prognostic factor in this group of patients. Methods: Altogether, 44 patients who underwent surgery for Intraabdominal metastases from melanoma with curative, cytoreductive, or palliative intent were analyzed. Results: There were 77 intraabdominal organ resections performed during the 44 operations. R0 resection was achieved in 19 (43 {\%}) cases. Factors associated with R0 resection were an absence of extra-abdominal metastases, low serum lactate dehydrogenase, involvement of fewer than three sites, and the presence of fewer than three metastatic lesions. The 1-, 3-, and 5-year overall survival rates were, respectively, 79, 66, and 44 {\%} in the curative intent group; 36, 18, and 9 {\%} in the cytoreduction group; and 21, 0 and 0 {\%} in the palliation group (curative intent vs. cytoreduction vs. palliation p <0.001). By Cox's multivariate analysis, the independent prognostic factors were time from excision of primary melanoma to the diagnosis of intraabdominal metastases, NLR, and residual disease after surgery. Conclusions: Our results confirm the usefulness of major surgical interventions as reported in previous studies. We reviewed recent evidence that immunologic phenomena may explain the unexpectedly good response rate in patients with advanced disease. The simple estimation of the NLR has been advocated as a prognostic marker for several cancers. We show that it is likewise useful in metastatic melanoma. We stress the need for developing additional immunologic markers.",
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