Association of monocyte-to-lymphocyte ratio with coronary endothelial dysfunction and cardiovascular events in patients with angina and nonobstructive coronary artery disease.

Monocyte to lymphocyte ratio (MLR) has been confirmed as a novel marker of poor prognosis in patients with coronary heart disease (CAD). However, the prognosis value of MLR for patients with CAD after percutaneous coronary intervention (PCI) needs further studies. In present study, we aimed to investigate the correlation between MLR and long-term prognosis in patients with CAD after PCI. A total of 3,461 patients with CAD after PCI at the First Affiliated Hospital of Zhengzhou University were included in the analysis. According to the cutoff value of MLR, all of the patients were divided into 2 groups: the low-MLR group (<0.34, n = 2338) and the high-MLR group (≥0.34, n = 1123). Kaplan–Meier curve was performed to compare the long-term outcome. Multivariate COX regression analysis was used to assess the independent predictors for all-cause mortality, cardiac mortality and MACCEs. Multivariate COX regression analysis showed that the high MLR group had significantly increased all-cause mortality (ACM) [hazard ratio (HR) = 1.366, 95% confidence interval (CI): 1.366-3.650, p = 0.001] and cardiac mortality (CM) (HR = 2.379, 95%CI: 1.611-3,511, p < 0.001) compared to the low MLR group. And high MLR was also found to be highly associated with major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 1.227, 95%CI: 1.003-1.500, p = 0.047) in patients with CAD undergoing PCI. MLR was an independent predictor of ACM, CM and MACCEs in CAD patients who underwent PCI.

Introduction: TNBC is overrepresented in Black women, and Black patients (pts) with TNBC have worse clinical outcomes compared to non-Black pts. Neoadjuvant chemotherapy (NACT) +/- immunotherapy is current standard of care for early-stage TNBC. Immune response parameters including sTILs are important predictors of response to NACT and long-term outcomes in TNBC. Circulating blood cell counts may be indicators of the systemic immune environment and thus play a role in response to NACT. Racial differences in sTILs and peripheral white blood cell components and their combined impact on outcomes are not well studied in TNBC. Methods: 469 pts with stage I-III TNBC enrolled in a prospective registry between 2011-2023 who received NACT (n=321) or NACT + pembrolizumab (P) (n=148) were included in analysis. Absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and absolute monocyte count (AMC) were extracted from complete blood count (CBC) obtained prior to starting NACT. sTILs were centrally quantified as previously described. Impact of sTILs and CBC components (ANC, ALC, AMC, NLR (neutrophil to lymphocyte ratio), LMR (lymphocyte to monocyte ratio), and platelet to lymphocyte ratio (PLR)) on pathologic complete response (pCR) and recurrence free survival (RFS) was evaluated. Results: Among 469 pts, 33% had node positive disease; 81% were White, 14% Black, and 2% Asian. Pts who received NACT+P were more likely to have higher T stage (p=0.005) and TNM stage (p=0.004) and shorter follow up compared to those who received NACT alone. Black pts had lower ANC (median 3.6 vs 4.6 k/uL, p&amp;lt;0.001) and NLR (median 1.6 vs 2.5, p&amp;lt;0.001), and higher ALC (median 2.2 vs 1.8 k/uL, p=0.003) and LMR (median 4.4 vs 3.8, p&amp;lt;0.001) compared to non-Black pts. AMC was numerically lower in Black pts, and PLR was similar between Black and non-Black pts. sTILs were available for 55% (n=257) of pts; Black pts had higher sTILs compared to non-Black pts (median 40% vs 10%, p=0.019). There was no association of sTILs with ANC, ALC, NLR, LMR, or PLR. There was a weak inverse association of sTILs with AMC (p=0.013). pCR rate was similar in Black and non-Black pts (52% vs 55%). sTILs were associated with pCR both as a continuous variable (odds ratio, OR 1.12 for every 10% increase, p=0.009) and at 30% cut point. None of the CBC components were associated with pCR. Increasing AMC and LMR were associated with lower RFS (AMC: hazard ratio, HR 1.11 for every 0.4 k/uL increase, p=0.019, LMR: HR 1.28 for every 1.0 increase, p=0.002). None of the other CBC components, sTILs, nor race were associated with RFS. On multivariable analysis that included T stage and nodal status, AMC and LMR were each independently associated with RFS (AMC: HR 1.10, p=0.054; LMR: HR 1.07, p=0.016). Conclusion: Among all circulating blood cell components, only the ones that included monocytes (AMC and LMR) independently impacted RFS, with higher monocytes being associated with worse outcomes in TNBC. Positive correlation between circulating monocytes and tumor-associated macrophages (TAMs) has been previously reported. It is also possible that the chemokine axis may recruit inflammatory monocytes into tumor sites, which may in turn differentiate into TAMs. We noted weak inverse association of AMC with sTILs, which also suggests some relationship between monocytes and the tumor immune microenvironment (TIM). Compared to non-Black pts, Black pts were more likely to have immune-enriched tumors (higher sTILs) but had more unfavorable peripheral white blood cell immune environment (higher LMR). These findings may partly explain why high sTILs do not translate into improved pCR rate and RFS in Black pts. Further investigation is warranted into the interaction between TIM, circulating monocytes, and race and how these interactions impact response to therapy. Citation Format: Priyanka Sharma, Rachel Yoder, Joshua M. Staley, India Fernandez, Adam Heinrich, Spencer Thompson, AnneMarie Ball, Trinity Kemp, Andrew K. Godwin, Rashna Madan, Qamar J. Khan, Robert Salgado, Shane R. Stecklein. Impact of racial differences in circulating blood components and stromal tumor-infiltrating lymphocytes (sTILs) on outcomes in triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS1-02.

ObjectiveThe aim of this study was to assess the association of neutrophil lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and system inflammation response index (SIRI) with the all-cause mortality and diabetes-cardiovascular mortality in participants with diabetic retinopathy (DR).MethodsA total of 572 participants with DR from NHANES were included, and divided into survival group (n = 440) and all-cause death group (n = 132). NLR = neutrophil count/lymphocyte count, MLR = monocyte count/lymphocyte count, SIRI = (neutrophil count × monocyte count)/lymphocyte count. We utilized the NHANES Public-Use Linked Mortality File through April 26, 2022, to determine mortality status. Diabetes-cardiovascular death was defined as death resulting from heart disease, cerebrovascular disease, or diabetes mellitus. The Spearson Correlation Analysis, Kaplan-Meier curves, Cox proportional hazards regression models, Restricted cubic spline plots and Decision Curve Analysis were used.ResultsThe all-cause mortality and diabetes-cardiovascular mortality were significantly higher in NLR ≥ 1.516, MLR ≥ 0.309, SIRI ≥ 0.756, and NLR + MLR + SIRI subgroups than NLR < 1.516, MLR < 0.309, SIRI < 0.756 subgroups, and other participants except NLR + MLR + SIRI (all P < 0.05). The HR of NLR, MLR, SIRI, NLR + MLR + SIRI for all-cause mortality were 1.979(1.13–3.468), 1.850(1.279–2.676), 1.821(1.096–3.025), 1.871(1.296–2.703), respectively. The hazard ratio of NLR, MLR, SIRI, NLR + MLR + SIRI for diabetes-cardiovascular mortality were 2.602(1.028–6.591), 2.673(1.483–4.818), 2.001(0.898–4.459), 2.554(1.426–4.575), respectively. In the restricted cubic spline plots, the relationship between NLR, MLR, SIRI and HR of all-cause mortality and diabetes-cardiovascular mortality was overall as “J” shaped. In both age < 60 and age > 60 years participants, the all-cause mortality and diabetes-cardiovascular mortality were significantly higher in NLR ≥ 1.516, MLR ≥ 0.309, SIRI ≥ 0.756, and NLR + MLR + SIRI subgroups than NLR < 1.516, MLR < 0.309, SIRI < 0.756 subgroups, and other participants except NLR + MLR + SIRI (all P < 0.05).ConclusionNLR, MLR, and SIRI may be three independent prognostic predictors for all-cause mortality and diabetes-cardiovascular mortality among individuals with DR. In practical clinical applications, combining NLR, MLR, and SIRI may enhance the prediction of all-cause mortality and diabetes-cardiovascular mortality in DR.

Introduction: Several studies have shown the role of inflammatory markers, especially the neutrophil-to-lymphocyte ratio (NLR), as indicators of poor prognosis in various gastrointestinal malignancies. We aimed to examine the prognostic value of NLR, among other markers, and their relationship with the presence of baseline distant metastasis in patients with pancreatic adenocarcinoma. Methods: We retrospectively reviewed the charts of 355 patients with pancreatic cancer treated at a tertiary cancer center from 2013 to 2018. We examined the relationship between absolute eosinophilic count (AEC), absolute lymphocyte count (ALC), absolute monocytic count (AMC), absolute neutrophil count (ANC), monocyte to lymphocyte ratio (MLR), NLR, and platelet to lymphocyte ratio (PLR) with the presence distant metastases, and overall survival (OS). We used multivariable logistic regression analyses to test the association between the variables and the presence of baseline distant metastases. Results: The median age was 60 years, and males comprised 59% of the patients. The ROC value of 3.3 was determined as the cutoff value for NLR. High NLR (NLR >3.3 µL) was significantly associated with the presence of distant metastasis at diagnosis (P-value < 0.0001, Odds Ratio (OR): 1.7, CI: 2.6–4.0). High baseline ANC (≥5500/μL), high AMC (≥600/μL), and high MLR (≥0.3) were also associated with baseline distant metastases (P-value: 0.02, 0.001, and <0.0001 respectively). Multivariable analysis showed that high NLR (P-value, 0.0003, OR 2.5 95% CI 1.5–4.1) was an independent risk factor for distant metastasis at presentation. High ANC, NLR, MLR, and PLR and low ALC were associated with poor OS (P-value: <0.0001, <0.0001, <0.0001, 0.04, and 0.01, respectively) (Figure 1). Conclusion: High systemic inflammatory markers are associated with poor prognosis (the presence of distant metastasis) and poor OS in patients with pancreatic cancer. Simple laboratory tests such as complete blood counts can be used as markers of poor prognosis and poor OS in patients with pancreatic cancer (Table 1). Table 1. - The association between systemic inflammatory markers with the presence of distant metastases Baseline distant metastases Present Absent p- value Odds Ratio 95% Confidence Interval ANC≥5500 113 (64%) 63 (36%) 0.024 1.65 (1.0-2.5) ANC< 5500 92 (52%) 85 (48%) ALC≥1680 99 (57%) 75 (43%) 0.65 0.9 (0.6-1.4) ALC< 1680 106 (59%) 73 (41%) AMC≥ 600 117 (66%) 59 (34%) 0.001 2.0 (1.3-3.0) AMC< 600 88 (50%) 89 (50%) AEC≥ 143 83 (62%) 51 (38%) 0.38 1.2 (0.7-2.0) AEC< 143 76(57%) 58 (43%) NLR≥3.3 126 (69%) 56 (31%) < .0001 2.6 (1.7-4.0) NLR< 3.3 79 (46%) 92 (54%) MLR≥0.3 130 (68%) 62 (32%) < .0001 2.4 (1.5-3.7) MLR< 0.3 75 (46%) 86 (54%) PLR≥0.15 108 (61%) 68 (39%) 0.2 1.3 (0.85-2.0) PLR< 0.15 97 (55%) 80 (45%) Figure 1.: Kaplan Meier curve for overall survival with NLRFigure 2.: Kaplan Meier curve for overall survival with ANCFigure 3.: Kaplan Meier curve for overall survival with ALC

ObjectiveThis study evaluated the prognostic significance of preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and tumor-infiltrating lymphocytes (TILs), and whether these preoperative blood inflammatory indicators were associated with TILs in hilar cholangiocarcinoma (HCCA).MethodsA total of 76 patients with HCCA who underwent radical resection were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. The optimal cutoff levels for the NLR, PLR and LMR were defined by using the web application Cut-off Finder. The densities of specific immune cells (CD3+, CD4+, CD8+) within the tumor microenvironment were examined by immunohistochemical. The association of the number of CD3+, CD4+ and CD8+ T cells infiltration in the local tumor microenvironment with preoperative NLR, PLR and LMR level was analyzed. Survival curves were calculated using the Kaplan–Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with overall survival.ResultsThe optimal cutoff value of preoperative NLR, PLR and LMR was 2.00, 117.60, and 4.02, respectively. NLR was significantly negatively correlated with CD3+ and CD8+ T cell infiltration, but not with CD4+ T cells. PLR had no correlation with CD3+, CD4+, or CD8+ T cell infiltration, while LMR had a significantly positive correlation with CD3+ T cells infiltration but not with CD4+ or CD8+ T cells. In the multivariate logistic regression model, T stage, lymph node metastasis, CA19-9 and LMR were independent risk factors associated with overall survival (OS). Survival curves indicated that HCCA patients with low CD3+ T cells infiltration and low preoperative LMR live shorter than others.ConclusionsLMR played as an independent factor for predicting the survival in patients with HCCA after R0 radical resection. A high LMR was associated with an accumulation of CD3+ T cells in HCCA.

BackgroundLower lymphocyte to monocyte ratio (LMR), higher neutrophil to lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS) 2 have been demonstrated as independent prognostic markers for poor prognosis of advanced non-small cell lung cancer (NSCLC). However, little is known about these three markers as prognostic markers for a specific histological subset of NSCLC, squamous cell carcinoma (SCC). This study aimed to evaluate the prognostic significance of LMR, NLR and mGPS for advanced SCC.MethodsWe retrospectively collected 107 patients who met the following criteria: pathologically confirmed SCC, chemo-naive patients who had initiated first-line cytotoxic chemotherapy between September 2007 and February 2017 at our institution, and c-stage IIIB, IV or recurrence after curative-intent surgery or thoracic radiotherapy. In order to demonstrate these three markers as significant prognostic factors, we compared overall survival (OS) between two groups divided by LMR, NLR and mGPS 0 - 1 versus 2, and performed univariate and multivariate Cox proportional hazard analyses.ResultsGroups with low LMR (< 2.07) and high NLR (≥ 5.28) experienced shorter OS (LMR: 6.5 versus 15.6 months in median, P < 0.01; NLR: 8.2 versus 15.6 months, P < 0.01) than groups with high LMR (≥ 2.07) and low NLR (< 5.28). However, no significant difference was detected in OS between mGPS 0 - 1 and 2 (13.0 versus 13.7 months, P = 0.61). As significant poor prognostic factors, our multivariate Cox hazard analysis detected ECOG PS 2 - 4 (hazard ration (HR): 3.09, 95% confidence interval (CI): 1.77 - 5.40; P < 0.01) and LMR < 2.07 (HR: 0.39, 95% CI: 0.21 - 0.79; P < 0.01). However, NLR was not selected in the multivariate analysis.ConclusionLMR is an independent prognostic factor for advanced pulmonary SCC. Neither NLR nor mGPS is useful as prognostic factor for this histology. The optimal prognostic markers may differ from each subset of NSCLC.

Objective: To investigate the efficacy and prognosis of the dynamic monitoring lymphocyte to monocyte ratio (LMR) in patients with diffuse large B-cell lymphoma (DLBCL). Methods: The clinical data of 261 patients with DLBCL in the Affiliated Cancer Hospital of Zhengzhou University between March 2012 to March 2018, were analyzed retrospectively. The optimal cut-off values of LMR was determined using the receiver operating characteristic curve (ROC) method. Patients were divided into low LMR group and high LMR group according to the optimal cut-off value. The changes of LMR before and after treatment in two groups were dynamically monitored, and the relationship between LMR and efficacy and survival were analyzed. Results: Complete remission (CR) rate in patients with high LMR (64.7%) before treatment was significantly higher than that in patients with low LMR (33.3%) (P<0.05). Compared with the 5-year overall survival(OS) and progress free survival(PFS) (56.96% and 43.55%, respectively) in the low LMR group, the 5-year OS and PFS (82.92% and 66.25%, respectively) in the high LMR group were higher, and the difference was statistically significant (all P<0.05). Patients with elevated LMR after treatment in the high or low LMR group had a significant higher 5-year OS and PFS compared with patients with LMR reduction(P<0.05). LMR in both high and low LMR group were significantly lower at the last follow-up than those at the disease recurrence (all P<0.05). Both single and multivariate analyses showed that low LMR was an independent prognostic factor in patients with DLBCL (all P<0.05). Conclusions: LMR can be used as an indicator of risk stratification, efficacy, disease replase and prognosis in patients with DLBCL. Low LMR before and after treatment were poor prognostic factors in patients with DLBCL.

The occurrence of lupus nephritis is primarily caused by the dysfunction of the autoimmune system, leading to the deposition of immune complexes (ICs) in the kidneys and associated inflammatory responses. Lymphocyte-related parameters, including the platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR), have been confirmed in recent years as important novel indicators for several inflammatory diseases. However, it remains unclear whether lymphocyte-related parameters can serve as prognostic indicators for lupus nephritis (LN). This study included a total of 143 LN patients, who were divided into several groups based on the optimal cutoff values of lymphocyte-related parameters. The primary endpoint was poor renal prognosis, and the patients' prognosis was monitored through follow-up, recording the time at which patients reached the study endpoint. The predictive effect was evaluated using the area under the receiver operating characteristic curve (AUROC), Kaplan-Meier (K-M) curves, and Cox proportional hazards analysis. Compared with the healthy control group, the PLR, NLR, and MLR levels in the LN group were significantly higher (P < 0.05). Kaplan-Meier survival analysis showed that patients with high PLR, NLR, and MLR had poorer prognosis (P < 0.05). Univariate Cox regression analysis indicated that PLR (HR 1.002, 95% CI 1.000-1.004, P = 0.05) and NLR (HR 1.081, 95% CI 1.031-1.134, P = 0.001) were associated with kidney progression. Multivariate Cox regression analysis showed that only MLR (HR 5.861, 95% CI 1.515-22.665, P = 0.010) was an independent risk factor affecting the renal prognosis of LN patients, whereas PLR and NLR were not. Based on the cutoff value of MLR, patients were divided into two groups. In terms of general data, the high MLR group had a significantly higher mean arterial pressure compared to the low MLR group (P = 0.002). In terms of laboratory tests, the high MLR group had a significantly lower eGFR compared to the low MLR group (P = 0.001). In terms of renal pathology, the high MLR group showed statistically significant differences compared to the low MLR group in AI index, CI index, capillary endothelial cell proliferation, cellular/fibrous crescent formation, and interstitial inflammatory cell infiltration (P < 0.05). MLR may serve as an independent risk factor for poor renal prognosis in SLE patients.

To assess the effects of calcium channel blockers on development of infarcts, reinfarction, and mortality. A systematic overview of all randomised trials of calcium channel blockers in myocardial infarction and unstable angina. 19,000 Patients in 28 randomised trials. In the trials of myocardial infarction 873 deaths occurred among 8870 patients randomised to active treatment compared with 825 deaths among 8889 control patients (odds ratio of 1.06, 95% confidence interval of 0.96 to 1.18). There was no evidence of a beneficial effect on development and size of infarcts or rate of reinfarction. The results were similar in short term trials in which treatment was confined to the acute phase and those in which treatment was started some weeks later and continued for a year or two. There was no evidence of heterogeneity among different calcium channel blockers in their effects on any end point. The results were similar in the unstable angina trials (110 out of 561 patients treated with calcium channel blocker compared with 104 out of 548 controls developed a myocardial infarction; 14 out of 591 treated compared with nine out of 578 controls died). Calcium channel blockers do not reduce the risk of initial or recurrent infarction or death when given routinely to patients with acute myocardial infarction or unstable angina.

ObjectivesThis study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST...

e12623 Background: Hematologic markers have been looked at as potential prognostic biomarkers in a variety of cancers. Ni and colleagues (2014) have shown that an elevated pre-treatment lymphocyte-to-monocyte ratio (LMR) was significantly associated with improved disease-free survival (DFS) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NACT). Given the prognostic implications of hematologic inflammatory parameters, we sought to understand if such biomarkers will predict response to neoadjuvant chemotherapy (NACT) in patients with breast cancer. Methods: We conducted a retrospective review of breast cancer patients treated with NACT at our institution (2008-2018). Data on patient characteristics, stage, pathologic characteristics, and blood counts were collected. Blood parameters prior to NACT were used to calculate LMR and neutrophil-to-lymphocyte ratio (NLR). To test the impact of LMR and NLR on pathologic response, a two sample mean test was used first as univariate analysis. Next, logistic regression was employed for multivariate analysis controlling for patient characteristics with interaction of LMR and NLR with ER, PR and HER2 status. Results: A total of 50 patients were included. 38% of patients achieved a pathologic complete response (pCR). The mean LMR was 3.69 (1.4-12.5), and the mean NLR was 2.55 (0.66 – 9.31). On univariate analysis, a high NLR was associated with a higher likelihood of achieving a pCR (OR = 1.64, 95% CI = 1.01-2.63). A high LMR was associated with a higher likelihood of pCR; however, this was not statistically significant (OR = 1.08, 95% CI = 0.78-1.47). On multivariate analysis, patients with HER-2 positive disease with a high LMR had a significantly higher chance of having a pCR (OR = 1.72, 95% CI = 1.06-2.78). Conclusions: Our study showed that NLR was a predictor of pCR in breast cancer patients receiving neoadjuvant chemotherapy. A high NLR was associated with achieving a pCR on univariate analysis. Multivariate analysis suggested that HER-2 positive disease with a high LMR had a significantly higher chance of achieving a pCR. The results of this cohort correlate with previous reports by others showing that pre-NACT LMR and NLR provide prognostic information in patients with breast cancer. Although limited by sample size, this adds to the growing body of literature supporting peripheral blood counts as a biomarker for outcomes in breast cancer.

Prognostic Relevance of Neutrophil to Lymphocyte Ratio (NLR) and Lymphocyte to Monocyte Ratio (LMR) in Newly Diagnosed Advanced-Stage Hodgkin Lymphoma Patients Treated up-Front with a PET-2 Risk Adapted Protocol

Background Cardiogenic embolism by left atrial thrombi is one of the most important atrial fibrillation (AF)-related clinical problems. In a previous survey, 91% of nonrheumatic AF-related left atrial thrombi was originated in the left atrial appendage (LAA). The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019. The WATCHMAN family is the only left atrial appendage closure (LAAC) device in Japan. After percutaneous left atrial appendage closure (LAAC), DRT is an important issue in some cases. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are known as cancer prognostic factors and indicators of immune status. There are few reports on the predictor for device related thrombosis (DRT), transient ischemic attack (TIA), and ischemic stroke. Finding novel biomarkers could help clinical decision in antithrombotic therapy post LAAC and follow-up intervals. Purpose To investigate the association of NLR, PLR, and LMR with device related thrombosis, transient ischemic attack, and ischemic stroke in patients with LAAC. Methods Our database of LAAC was respectively analyzed. All LAAC cases were performed between January 2020 and September 2023. Blood cell counts were sampled in three days before LAAC. Postoperative antithrombotic therapy was individualized based on the patient’s background. We examined their background and clinical events. Results A total of 116 consecutive patients underwent LAAC in our institution excepting for one case that could not be performed due to a huge LAA (follow-up period, 610±37 days; age, 75±1 years; male sex, 73%; left ventricular ejection fraction, 58±1%; CHAD2S2-VASc, 4.6±0.1; HAS-BLED, 3.4±0.1). The results are shown in the Figure. Receiver-operating characteristic curve analysis confirmed the best cut-off value of NLR, PLR, and LMR for composite of DRT, TIA, and ischemic stroke (AUC = 0.69; 0.70; 0.67). In the univariate analysis, NLR&amp;lt;1.88, PLR&amp;lt;144, and LMR&amp;gt;3.40 are the independent predictor for the combination of DRT, TIA, and ischemic stroke (p-value = 0.02; 0.04; 0.05, respectively). Conclusion Low NLR, low PLR, and high LMR are the independent predictor for the combination of DRT, TIA, and ischemic stroke. These parameters can be useful in routine use because they can be easily calculated without additional costs.

Purpose: Many reports have provided real-world evidence that inflammatory response biomarker (IRB) scores may be useful for predicting the therapeutic effect of chemotherapy and the prognosis for various neoplasms. The aim of this retrospective study was to evaluate the clinical roles of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) as predictive factors of Paclitaxel + Bevacizumab (PB) therapy for patients with HER2-negative metastatic breast cancer (HER2-MBC). Methods: We reviewed the medical records of 123 HER2-MBC patients who underwent PB therapy in our institute. The NLR, PLR, and LMR were calculated from blood cell counts prior to the initiation of PB therapy. The optimal cut-off point of each ratio was determined according to receiver operating characteristic (ROC) curves. The Kaplan-Meier test and Wilcoxon test were used to analyze the progression- free survival (PFS) and overall survival (OS). The differences were considered significant for p &amp;lt; 0.05. Results: The median age at the start of treatment was 53 years old. Of the 123 patients, 98 (80%) were hormone- receptor- positive, and 82 (67%) had multiple (&amp;gt;2) metastatic sites. The median PFS was 7.0 months (95% confidence interval, 5.8-8.4), and the median treatment line before PB therapy was 0 (range: 0-10). The cut-off points of the NLR, PLR, and LMR for the PFS and OS were 2.7, 178, and 3.0, respectively. We found that a high NLR and low LMR were associated with a poor PFS (NLR, median 6.5 vs. 8.4 months, p=0.04: LMR, median 5.6 vs. 8.1 months, p=0.02), and a high LMR was associated with a superior OS (median, not reached vs. 187 months, p=0.02) and 10- year survival rate (76.4% vs. 52.9%, p=0.02). The PLR showed no relationship with the PFS or OS. Conclusion: The NLR and LMR might be independent biomarkers, i.e. predictive factors, for patients with HER2-MBC receiving PB therapy in the real world. A prospective study to confirm the utility of those biomarkers is warranted. Citation Format: Tomomi Hayashi, Junichiro Watanabe, Shyogo Nakamoto. The prognostic and predictive roles of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in HER2-negative metastatic breast cancer patients treated with paclitaxel-bevacizumab [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-10-25.

Objective: Patients with acute coronary syndrome due to multivessel disease (MVD) were at the highest risk of adverse cardiovascular events. Neutrophil to lymphocyte ratio (NLR) was proposed as a marker of cardiovascular risk. Present study evaluated the independent predictive value of NLR for acute myocardial infarction (AMI) patients with MVD. Methods: AMI patients with MVD (n=1 433) underwent percutaneous coronary intervention (PCI) between January 2013 and December 2013 were followed up for 2 years. Patients were divided into 2 sub-groups based on an optimal cut off value of NLR to predict 2-year all-cause mortality. The primary endpoint was all-cause death. The secondary endpoint was long-term major adverse cardiovascular and cerebrovascular events (MACCE). Results: By receiver operating characteristics curve analysis, the optimal cut-off value of admission NLR to predict 2-year all-cause mortality was 3.39 (area under the curve 0.765, sensitivity 71%, specificity 73%). The high NLR group(n=396) had higher prevalence of prior myocardial infarction, prior PCI and intra-aortic balloon pump use (IABP)(P<0.01). Compared to the low NLR group (n=1 037), patients in the high NLR group were older, had higher level of neutrophil count and high-sensitivity C-reactive protein (hs-CRP) (P<0.001), but lower level of lymphocyte count, estimated glomerular filtration rate (eGFR) and ejection fraction (P<0.001). During the follow-up period, rate of long-term all-cause death was significantly higher in the high NLR group than in the low NLR group (5.1% (20/396) vs. 0.8% (8/1 037), P<0.001). Cardiac death (4.0% (16/396) vs. 0.7% (7/1 037), P<0.001) and MACCE (21.7% (86/396) vs. 12.6% (131/1 037), P<0.001) were also significantly higher in the high NLR group than in the low NLR group. Multivariate Cox analysis showed that NLR ≥ 3.39 was determined as an independent predictor of 2-year all-cause mortality (HR=3.23, 95%CI 1.38-7.54, P=0.007) and MACCE (HR=1.58, 95%CI 1.19-2.10, P=0.002) in this patient cohort after adjusting for other risk factors. Correlation analysis showed that the NLR was positively correlated with hs-CRP levels (r=0.241, P<0.001). Conclusion: Our study demonstrates that admission NLR ≥ 3.39 is an independent predictor of long term all cause death and MACCE in AMI patients with MVD post PCI.