Perioperative examination of inflammatory markers in relation to sentinel lymph node biopsy in patients with melanoma; a pilot study
Author
Kristjansen, Karoline Assifuah
Term
5. Term (Master thesis)
Education
Publication year
2023
Abstract
Formålet med dette pilotstudie var at undersøge, om sentinel node-biopsi (SLNB), som er central for stadieinddeling af melanom og udvælgelse til adjuverende immunterapi, udløser en systemisk inflammatorisk respons. Vi gennemførte et prospektivt, monocentrisk, ukontrolleret longitudinelt studie med 20 patienter med melanom, hvor der blev taget blodprøver præoperativt samt 2 og 6 timer postoperativt. Der blev målt leukocyttal med særlig fokus på neutrofil-til-lymfocyt-ratio (NLR), pro-inflammatoriske cytokiner (herunder IL-6, IL-10, TNF-α og IFN-γ) samt akutfasereaktanter (CRP og LDH). NLR steg signifikant fra 1,94 præoperativt til 9,5 efter 2 timer og 16,04 efter 6 timer, i overensstemmelse med en moderat systemisk inflammation. Samtidig steg neutrofile, mens lymfocytter faldt. Blandt cytokinerne steg IL-6 og IL-10 fra baseline til 2 timer, mens TNF-α og IFN-γ faldt ved både 2 og 6 timer; CRP og LDH ændrede sig ikke, og øvrige cytokiner viste ingen signifikante ændringer. Fundene tyder på, at SLNB inducerer en moderat perioperativ systemisk inflammatorisk respons, hvilket understreger behovet for yderligere forskning i, hvordan perioperativ inflammation kan påvirke mikrometastaser og prognose samt om responsen kan målrettes i behandlingen.
This pilot study examined whether sentinel lymph node biopsy (SLNB), a key procedure for melanoma staging and selection for adjuvant immunotherapy, triggers a systemic inflammatory response. We conducted a prospective, single-center, uncontrolled longitudinal study including 20 melanoma patients, with blood sampling before surgery and at 2 and 6 hours postoperatively. Measurements included leukocyte differential counts with focus on the neutrophil-to-lymphocyte ratio (NLR), pro-inflammatory cytokines (including IL-6, IL-10, TNF-α, and IFN-γ), and acute phase reactants (CRP and LDH). NLR increased significantly from 1.94 preoperatively to 9.5 at 2 hours and 16.04 at 6 hours, consistent with a moderate systemic inflammatory response. Neutrophils rose while lymphocytes decreased. Among cytokines, IL-6 and IL-10 increased from baseline to 2 hours, whereas TNF-α and IFN-γ decreased at both 2 and 6 hours; CRP and LDH showed no perioperative changes, and other cytokines remained nonsignificant. These findings indicate that SLNB induces a moderate perioperative systemic inflammatory response, highlighting the need for further studies on how perioperative inflammation may influence micrometastases and prognosis and whether it could be targeted therapeutically.
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