Schmidt Henrik, Suciu Stefan, Punt Cornelis J A, Gore Martin, Kruit Wim, Patel Poulam, Lienard Danielle, von der Maase Hans, Eggermont Alexander M M, Keilholz Ulrich
Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
J Clin Oncol. 2007 Apr 20;25(12):1562-9. doi: 10.1200/JCO.2006.09.0274.
An elevated count of blood neutrophils and monocytes recently was shown independently to predict short survival in patients with stage IV melanoma undergoing interleukin-2-based immunotherapy. In this study, we aimed to validate this finding in a large cohort of stage IV melanoma patients.
For this retrospective prognostic study, the data from the European Organisation for the Research and Treatment of Cancer 18951 study were used. Patients were randomly assigned between treatment with dacarbazine, cisplatin, and interferon alfa with or without interleukin-2. Counts of neutrophils and leukocytes were analyzed together with other known prognostic factors: serum lactate dehydrogenase, performance status, metastatic site, and sex. Two multivariate prognostic factor analyses were carried out in the model: one with leukocyte counts and one with neutrophil counts.
A total of 363 patients were randomly assigned and baseline blood neutrophil and leukocyte counts were available from 316 and 350 patients, respectively. A high neutrophil count (> 7.5 x 10(9)/L) was an independent prognostic factor for short overall survival (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = 0.02), and a high leukocyte count (> 10 x 10(9)/L) was an independent prognostic factor of both short overall survival (HR, 1.7; 95% CI, 1.3 to 2.4; P = 0.0005) and short progression-free survival (HR, 1.5; 95% CI, 1.1 to 2.1; P = 0.008).
A high pretreatment count of neutrophils in blood was confirmed as an independent prognostic factor for short overall survival in stage IV melanoma patients undergoing interleukin-2-based immunotherapy. Furthermore, a high count of leukocytes was an independent prognostic factor for short overall survival and progression-free survival. Both parameters should be useful as stratification factors in clinical trials.
近期研究表明，血液中性粒细胞和单核细胞计数升高可独立预测接受白细胞介素-2免疫治疗的IV期黑色素瘤患者的短期生存期。在本研究中，我们旨在在一大群IV期黑色素瘤患者中验证这一发现。
对于这项回顾性预后研究，使用了欧洲癌症研究与治疗组织18951研究的数据。患者被随机分配接受达卡巴嗪、顺铂和干扰素α联合或不联合白细胞介素-2的治疗。分析了中性粒细胞和白细胞计数以及其他已知的预后因素：血清乳酸脱氢酶、体能状态、转移部位和性别。在模型中进行了两项多变量预后因素分析：一项是白细胞计数分析，另一项是中性粒细胞计数分析。
共有363例患者被随机分配，分别有316例和350例患者获得了基线血液中性粒细胞和白细胞计数。高中性粒细胞计数（>7.5×10⁹/L）是总生存期短的独立预后因素（风险比[HR]，1.5；95%可信区间[CI]，1.1至2.1；P = 0.02），高白细胞计数（>10×10⁹/L）是总生存期短（HR，1.7；95%CI，1.3至2.4；P = 0.0005）和无进展生存期短（HR，1.5；95%CI，1.1至2.1；P = 0.008）的独立预后因素。
血液中预处理时的高中性粒细胞计数被确认为接受白细胞介素-2免疫治疗的IV期黑色素瘤患者总生存期短的独立预后因素。此外，高白细胞计数是总生存期短和无进展生存期短的独立预后因素。这两个参数都应作为临床试验中的分层因素。
