RESUMEN
Although adjuvant therapies with immune checkpoint inhibitors (ICI) and BRAF/MEK inhibitors improve recurrence-free survival (RFS) in stage III melanoma patients significantly, prognostic factors are needed to identify patients with a high risk of disease recurrence. Therefore, the aim of our study was to investigate the prognostic potential of routinely collected blood parameters for stage III melanoma patients with microscopic sentinel lymph node (SLN) metastasis. Altogether, we retrospectively analyzed 138 stage III melanoma patients who were diagnosed with microscopic SLN metastasis at the skin cancer center of the University Hospital Cologne between 2011 and 2020 and who did not receive prior adjuvant therapy with ICI or BRAF/MEK-inhibitors. Univariate and multivariate Cox regression analyses, Kaplan-Meier survival analyses and receiver operating characteristic (ROC) curves were performed to assess the impact of preoperatively collected blood parameters and blood ratios on recurrence-free survival (RFS; primary endpoint) and overall survival (OS). A high neutrophil-to-lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR) and high C-reactive protein (CRP) value were significantly associated with shorter RFS in multivariate analysis. For LMR (cut-off 3.5) and for CRP (cut-off 3.0) this effect remained after dichotomization. CRP showed a stronger association with RFS than NLR or LMR, with the highest association being detected for the combination of low LMR and high CRP. Additionally, derived NLR ≥ 2.0 was significantly associated with shorter OS in multivariate analysis. In summary, our data suggest that CRP in combination with LMR should be considered as a marker for melanoma recurrence in stage III melanoma patients with microscopic SLN metastasis.
RESUMEN
Fatigued driving is one of the main contributors to road traffic accidents. Poor sleep quality and lack of sleep negatively affect driving performance, and extreme states of fatigue can cause microsleep (i.e., short episodes of sleep with complete loss of awareness). Driver monitoring systems analyse biosignals (e.g., gaze, blinking, heart rate) and vehicle data (e.g., steering wheel movements, lane holding, acceleration) to detect states of fatigue and prevent accidents. We argue that inter-individual differences in personality, sensation seeking behaviour, and intelligence could improve microsleep prediction, in addition to sleepiness. We tested 144 male participants in a supervised driving track after 27 hours of sleep deprivation. More than 74% of drivers experienced microsleep, after an average driving time of 52 min. Overall, prediction models for microsleep vulnerability and driving time before microsleep were significantly improved by conscientiousness, sensation seeking and non-verbal IQ, in addition to situational sleepiness, as individual risk factors. Practitioner summary: This study offers valuable insights for the design of driver monitoring systems. The use of individual risk factors such as conscientiousness, sensation seeking, and non-verbal IQ can increase microsleep prediction. These findings may improve monitoring systems based solely on physiological signals (e.g., blinking, heart rate) and vehicle data (e.g., steering wheel movements, acceleration, cornering). Abbreviations: ADAC: Allgemeiner Deutscher Automobil Club; ANOVA: analysis of variance; AIC: Akaike information criteria; CI: confidence interval; GPS: global positioning system; IQ: intelligence quotient; IQR: inter quartile range; KSS: Karolinska sleepiness scale; NEO-PI-R: revised NEO personality inventory; OLS: ordinary least squares; PSQI: Pittsburgh sleep quality index; SPM: standard progressive matrices; SSS: sensation seeking scale; WHO: World Health Organization.
