TY - JOUR
T1 - MelRisk: Using the neutrophil-to-lymphocyte ratio to improve risk prediction models for metastatic cutaneous melanoma in the sentinel lymph node
AU - Wade, Ryckie G.
AU - Bailey, Samuel
AU - Robinson, Alyss V.
AU - Lo, Michelle C. I.
AU - Peach, Howard
AU - Moncrieff, Marc
AU - Martin, James
N1 - Funding Information: Ryckie Wade is a Doctoral Research Fellow funded by the National Institute for Health Research (NIHR, DRF-2018-11-ST2-028). The views expressed are those of the author(s) and not necessarily those of the United Kingdom's National Health Service, NIHR or Department of Health.
Further information: The authors thank James Smith, Donald J Dewar and Jenny Goodenough for testing the app at the alpha and beta stages. Ethical approval was gained from the local (reference PL15/368) and United Kingdom National Health Research Authority (HRA, IRAS ID: 234565). There was no requirement to take consent from patients for this study, as determined by the UK HRA given that the study used historical data that was already captured and there was no need to interface with patients.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Identifying metastatic melanoma in the sentinel lymph node (SLN) is important because 80% of SLN biopsies are negative and 11% of patients develop complications. The neutrophil-to-lymphocyte ratio (NLR), a biomarker of micrometastatic disease, could improve prediction models for SLN status. We externally validated existing models and developed ‘MelRisk’ prognostic score to better predict SLN metastasis. Methods: The models were externally validated using data from a multicenter cohort study of 1,251 adults. Additionally, we developed and internally validated a new prognostic score `MelRisk’, using candidate predictors derived from the extant literature. Results: The Karakousis model had a C-statistic of 0.58 (95% CI, 0.54–0.62). The Sondak model had a C-statistic of 0.57 (95% CI 0.53–0.61). The MIA model had a C-statistic of 0.60 (95% CI. 0.56–0.64). Our ‘MelRisk’ model (which used Breslow thickness, ulceration, age, anatomical site, and the NLR) showed an adjusted C-statistic of 0.63 (95% CI, 0.56–0.64). Conclusion: Our prediction tool is freely available in the Google Play Store and Apple App Store, and we invite colleagues to externally validate its performance.
AB - Background: Identifying metastatic melanoma in the sentinel lymph node (SLN) is important because 80% of SLN biopsies are negative and 11% of patients develop complications. The neutrophil-to-lymphocyte ratio (NLR), a biomarker of micrometastatic disease, could improve prediction models for SLN status. We externally validated existing models and developed ‘MelRisk’ prognostic score to better predict SLN metastasis. Methods: The models were externally validated using data from a multicenter cohort study of 1,251 adults. Additionally, we developed and internally validated a new prognostic score `MelRisk’, using candidate predictors derived from the extant literature. Results: The Karakousis model had a C-statistic of 0.58 (95% CI, 0.54–0.62). The Sondak model had a C-statistic of 0.57 (95% CI 0.53–0.61). The MIA model had a C-statistic of 0.60 (95% CI. 0.56–0.64). Our ‘MelRisk’ model (which used Breslow thickness, ulceration, age, anatomical site, and the NLR) showed an adjusted C-statistic of 0.63 (95% CI, 0.56–0.64). Conclusion: Our prediction tool is freely available in the Google Play Store and Apple App Store, and we invite colleagues to externally validate its performance.
KW - Lymphocytes
KW - Melanoma
KW - Neutrophils
KW - Risk
KW - Sentinel Lymph Node
UR - https://www.scopus.com/pages/publications/85121717843
U2 - 10.1016/j.bjps.2021.11.088
DO - 10.1016/j.bjps.2021.11.088
M3 - Article
SN - 1748-6815
VL - 75
SP - 1653
EP - 1660
JO - Journal of Plastic, Reconstructive and Aesthetic Surgery
JF - Journal of Plastic, Reconstructive and Aesthetic Surgery
IS - 5
ER -