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

Schmidt H, Bastholt L, Geertsen P, Christensen IJ, Larsen S, Gehl J, von der Maase H - Br. J. Cancer (2005)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark. hesch@as.aaa.dk

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.

Show MeSH

Related in: MedlinePlus

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.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2361564&req=5

fig2: 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.

Mentions: Based on the ratios of regression coefficients (log hazard ratios in the final Cox's model) of variables, we defined the weights of prognostic factors as follows: elevated LDH was assigned weight 2, elevated neutrophil counts weight 1 and performance status of 2 weight 1. A prognostic score of the cumulated weights of these variables was used to assign patients to low-risk (none elevated, score 0), intermediate-risk (any combination of 1–2 elevated variables, score 1–3) and high-risk (all three variables elevated, score 4) groups, respectively. The median survival of low-risk (n=139), intermediate-risk (n=161) and high-risk patients (n=21) was 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 (Figure 2A). The 5-year survival rates for these three groups were 9, 1 and 0%, respectively. The predicted 12-month survival probabilities were similar to the respective Kaplan–Meier estimates for each risk score. The 12-month survival probabilities predicted by the Cox's model were 48% (low risk), 14% (intermediate risk) and 1% (high risk), and the Kaplan–Meier estimates were 51, 13 and 0%, respectively. Similar differences were observed for the 24-month survival probabilities.


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

Schmidt H, Bastholt L, Geertsen P, Christensen IJ, Larsen S, Gehl J, von der Maase H - Br. J. Cancer (2005)

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.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361564&req=5

fig2: 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.
Mentions: Based on the ratios of regression coefficients (log hazard ratios in the final Cox's model) of variables, we defined the weights of prognostic factors as follows: elevated LDH was assigned weight 2, elevated neutrophil counts weight 1 and performance status of 2 weight 1. A prognostic score of the cumulated weights of these variables was used to assign patients to low-risk (none elevated, score 0), intermediate-risk (any combination of 1–2 elevated variables, score 1–3) and high-risk (all three variables elevated, score 4) groups, respectively. The median survival of low-risk (n=139), intermediate-risk (n=161) and high-risk patients (n=21) was 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 (Figure 2A). The 5-year survival rates for these three groups were 9, 1 and 0%, respectively. The predicted 12-month survival probabilities were similar to the respective Kaplan–Meier estimates for each risk score. The 12-month survival probabilities predicted by the Cox's model were 48% (low risk), 14% (intermediate risk) and 1% (high risk), and the Kaplan–Meier estimates were 51, 13 and 0%, respectively. Similar differences were observed for the 24-month survival probabilities.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark. hesch@as.aaa.dk

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.

Show MeSH
Related in: MedlinePlus