The prognostic role of the preoperative absolute lymphocyte count and absolute monocyte count in patients with resected advanced melanoma

Objectives: Published data have reported that components of the peripheral blood are significant prognostic factors in hematologic and solid malignancies. Thus, we sought to investigate if the preoperative absolute lymphocyte count (ALC) and absolute monocyte count (AMC) affects disease progression and survival after complete surgical resection of advanced malignant melanoma. Methods: We retrospectively reviewed records of 227 patients with resected advanced malignant melanoma (153 stage III and 74 stage IV) that were treated at the Mayo Clinic from 2000 to 2010. Survival analysis was performed using the Kaplan-Meier method, log-rank tests, and the Cox proportional hazards model for the univariate and multivariate analysis. Results: Surgically resected stage III melanoma patients with a preoperative AMC<0.6×10 9/L experienced a longer overall survival (OS) versus AMC≥0.6×10 9/L (median: 63.9 vs. 34.8 mo, respectively, P<0.008). Multivariate analysis showed AMC to be an independent predictor for OS in stage III patients. Stage IV resected melanoma patients with an ALC≥1.9×10 9/L experienced a superior median relapse-free survival (RFS) compared with patients with an ALC<1.9×10 9/L (median: 11.4 vs. 5.4 mo, respectively, P<0.006). Multivariate analysis showed ALC to be an independent predictor for RFS in stage IV patients. Conclusions: These data showed that in surgically resected stage III melanoma, preoperative AMC is an independent prognostic factor for OS. In contrast, a higher preoperative ALC is an independent prognostic for longer RFS in surgically resected stage IV melanoma.