A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study

J Am Acad Dermatol. 2016 Oct;75(4):712-721.e1. doi: 10.1016/j.jaad.2016.05.045. Epub 2016 Aug 17.

Abstract

Background: The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date.

Objective: We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC.

Methods: We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC.

Results: Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence.

Limitations: Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available.

Conclusion: A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline.

Keywords: Merkel cell carcinoma; absolute lymphocyte count; absolute neutrophil count; blood neutrophil-to-lymphocyte ratio; prognostic factor; specific survival.

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Biomarkers, Tumor / blood*
  • Carcinoma, Merkel Cell / blood*
  • Carcinoma, Merkel Cell / diagnosis
  • Carcinoma, Merkel Cell / mortality*
  • Cohort Studies
  • Disease-Free Survival
  • Female
  • Humans
  • Leukocyte Count
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Invasiveness / pathology
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neutrophils
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Skin Neoplasms / blood*
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / mortality*
  • Survival Rate

Substances

  • Biomarkers, Tumor