C-Reactive Protein and Lymphocyte-to-Monocyte Ratio Predict Recurrence in Stage III Melanoma Patients with Microscopic Sentinel Lymph Node Metastasis

Cancers (Basel). 2023 Jan 23;15(3):702. doi: 10.3390/cancers15030702.


Although adjuvant therapies with immune checkpoint inhibitors (ICI) and BRAF/MEK inhibitors improve recurrence-free survival (RFS) in stage III melanoma patients significantly, prognostic factors are needed to identify patients with a high risk of disease recurrence. Therefore, the aim of our study was to investigate the prognostic potential of routinely collected blood parameters for stage III melanoma patients with microscopic sentinel lymph node (SLN) metastasis. Altogether, we retrospectively analyzed 138 stage III melanoma patients who were diagnosed with microscopic SLN metastasis at the skin cancer center of the University Hospital Cologne between 2011 and 2020 and who did not receive prior adjuvant therapy with ICI or BRAF/MEK-inhibitors. Univariate and multivariate Cox regression analyses, Kaplan-Meier survival analyses and receiver operating characteristic (ROC) curves were performed to assess the impact of preoperatively collected blood parameters and blood ratios on recurrence-free survival (RFS; primary endpoint) and overall survival (OS). A high neutrophil-to-lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR) and high C-reactive protein (CRP) value were significantly associated with shorter RFS in multivariate analysis. For LMR (cut-off 3.5) and for CRP (cut-off 3.0) this effect remained after dichotomization. CRP showed a stronger association with RFS than NLR or LMR, with the highest association being detected for the combination of low LMR and high CRP. Additionally, derived NLR ≥ 2.0 was significantly associated with shorter OS in multivariate analysis. In summary, our data suggest that CRP in combination with LMR should be considered as a marker for melanoma recurrence in stage III melanoma patients with microscopic SLN metastasis.

Keywords: C-reactive protein (CRP); derived NLR; lymphocyte-to-monocyte ratio (LMR); melanoma; neutrophil-to-lymphocyte ratio (NLR); overall survival; platelet-to-lymphocyte ratio (PLR); recurrence-free survival; sentinel lymph node metastasis.

Grants and funding

C.F. was funded by the Köln Fortune Program of the University of Cologne (project numbers 498/2020 and 175/2022). S.H. received funding by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation, HO 6389/2-2, ‘KFO 337’—405344257. We acknowledge support for the Article Processing Charge from the DFG (German Research Foundation, 491454339). This research did not otherwise receive any specific grant from funding agencies in the public, commercial or non-profit sectors.