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. 2005 Aug 8;93(3):273-8.
doi: 10.1038/sj.bjc.6602702.

Elevated neutrophil and monocyte counts in peripheral blood are associated with poor survival in patients with metastatic melanoma: a prognostic model

H Schmidt  1 , L Bastholt, P Geertsen, I J Christensen, S Larsen, J Gehl, H von der Maase
Affiliations

Elevated neutrophil and monocyte counts in peripheral blood are associated with poor survival in patients with metastatic melanoma: a prognostic model

H Schmidt et al. Br J Cancer. .

Abstract

We aimed to create a prognostic model in metastatic melanoma based on independent prognostic factors in 321 patients receiving interleukin-2 (IL-2)-based immunotherapy with a median follow-up time for patients currently alive of 52 months (range 15-189 months). The patients were treated as part of several phase II protocols and the majority received treatment with intermediate dose subcutaneous IL-2 and interferon-alpha. Neutrophil and monocyte counts, lactate dehydrogenase (LDH), number of metastatic sites, location of metastases and performance status were all statistically significant prognostic factors in univariate analyses. Subsequently, a multivariate Cox's regression analysis identified elevated LDH (P<0.001, hazard ratio 2.8), elevated neutrophil counts (P=0.02, hazard ratio 1.4) and a performance status of 2 (P=0.008, hazard ratio 1.6) as independent prognostic factors for poor survival. An elevated monocyte count could replace an elevated neutrophil count. Patients were assigned to one of three risk groups according to the cumulative risk defined as the sum of simplified risk scores of the three independent prognostic factors. Low-, intermediate- and high-risk patients achieved a median survival of 12.6 months (95% confidence interval (CI), 11.4-13.8), 6.0 months (95% CI, 4.8-7.2) and 3.4 months (95% CI, 1.2-5.6), respectively. The low-risk group encompassed the majority of long-term survivors, whereas the patients in the high-risk group with a very poor prognosis should probably not be offered IL-2-based immunotherapy.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival estimates for 321 patients with metastatic melanoma according to baseline: (A) lactate dehydrogenase (LDH), (B) performance status, (C) blood neutrophils and (D) blood monocytes.
Figure 2
Figure 2
Kaplan–Meier survival estimates for 321 patients with metastatic melanoma according to combination factors: (A) prognostic model with low, intermediate and high risk. (B) AJCC stage IV classification: M1a, normal lactate dehydrogenase (LDH) and metastases confined to the skin and lymph nodes, M1b including lung metastases and normal LDH and M1c including other visceral organs or elevated serum LDH.
See this image and copyright information in PMC

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