Cutoff Value Of Lymphocyte-to-monocyte Ratio Research Articles

Lymphocyte-to-Monocyte Ratio Predicts Survival for Intraductal Papillary Mucinous Neoplasm with Associated Invasive Carcinoma of the Pancreas: Results from a High-volume Center.

Intraductal papillary mucinous neoplasm (IPMN) is an important precursor lesion of pancreatic cancer. Systemic inflammatory parameters are widely used in the prognosis prediction of cancer; however, their prognostic implications in IPMN with associated invasive carcinoma (IPMN-INV) are unclear. This study aims to explore the prognostic value of systemic inflammatory parameters in patients with IPMN-INV. From 2015 to 2021, patients with pathologically confirmed IPMN who underwent surgical resection at Peking Union Medical College Hospital were enrolled. The clinical, radiological and pathological data of the enrolled patients were collected and analyzed. Preoperative systemic inflammatory parameters were calculated as previously reported. Eighty-six patients with IPMN-INV met the inclusion criteria. The lymphocyte-to-monocyte ratio (LMR) was the only systemic inflammatory parameter independently associated with the cancer-specific survival (CSS). An LMR higher than 3.5 was significantly associated with a favorable CSS in univariate (hazard ratio (HR) 0.305, P = 0.003) and multivariate analyses (HR 0.221, P = 0.001). Other independently prognostic factors included the presence of clinical symptoms, cyst size, N stage and tumor differentiation. Additionally, a model including LMR was established for the prognosis prediction of IPMN-INV and had a C-index of 0.809. Preoperative LMR could serve as a feasible prognostic biomarker for IPMN-INV. A decreased LMR (cutoff value of 3.5) was an independent predictor of poor survival for IPMN-INV.

The Association of Pretreatment Systemic Immune Inflammatory Response Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR) with Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma.

Immunoinflammatory response can participate in the development of cancer. To investigate the relationship between pretreatment systemic immune inflammatory response index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and lymph node metastasis in patients with papillary thyroid carcinoma (PTC). A retrospective analysis was performed on 547 PTC patients treated in Meizhou People's Hospital from January 2018 to December 2021. Clinicopathological data were collected, including gender, age, Hashimoto's thyroiditis, maximum tumor diameter, extra-membrane infiltration, disease stage, BRAF V600E mutation, pretreatment inflammatory index levels, and lymph node metastasis. The optimal cutoff values of SII, SIRI, NLR, PLR and LMR were calculated by receiver operating characteristic (ROC) curve, and the relationship between inflammatory indexes and other clinicopathological features and lymph node metastasis was analyzed. There were 303 (55.4%) PTC patients with lymph node metastasis. The levels of SII, SIRI, NLR, and PLR in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, while the levels of LMR were significantly lower than those in patients without lymph node metastasis (all p<0.05). When lymph node metastasis was taken as the endpoint, the critical value of SII was 625.375, the SIRI cutoff value was 0.705, the NLR cutoff value was 1.915 (all area under the ROC curve >0.6). The results of regression logistic analysis showed that age <55 years old (OR: 1.626, 95% CI: 1.009-2.623, p=0.046), maximum tumor diameter >1cm (OR: 2.681, 95% CI: 1.819-3.952, p<0.001), BRAF V600E mutation (OR: 2.709, 95% CI: 1.542-4.759, p=0.001), SII positive (≥625.375/<625.375, OR: 2.663, 95% CI: 1.560-4.546, p<0.001), and NLR positive (≥1.915/<1.915, OR: 1.808, 95% CI: 1.118-2.923, p=0.016) were independent risk factors for lymph node metastasis of PTC. Age <55 years old, maximum tumor diameter >1cm, BRAF V600E mutation, SII positive, and NLR positive were independent risk factors for lymph node metastasis in PTC.

Prognostic value of pretreatment inflammatory biomarkers in patients with laryngeal cancer

The systemic inflammatory response is strongly involved in the progression of malignant tumors, and it is useful for predicting survival time and determining therapeutic effects. The inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are used to assess post-treatment survival and recurrence in various malignant tumors.(Walsh etal., 2005; Burt etal., 2011; Smith etal., 2009) 1,2,3 These indicators may be effective as predictive markers for head and neck malignancies. The participants were 125 glottic laryngeal and supraglottic cancer cases who received primary treatment in our department from 2010 to 2016. The NLR, LMR, and PLR for each patient were calculated in addition to the association with overall survival (OS) rate, disease-specific survival (DSS) rate, and laryngeal preservation rate for tumor location, T and N classification, TNM stage classification, treatment, and smoking. We investigated whether inflammatory biomarkers are useful for predicting prognosis. The cutoff values for NLR, LMR, and PLR on the ROC curve were 1.88, 5.57, and 108, respectively. Multivariate analysis with LMR 5.57 as the cutoff value showed significant differences in OS, DSS, and laryngeal preservation. However, setting the cutoff values for NLR 1.88 and PLR 108 showed significant differences only in OS and laryngeal preservation. LMR may be a total survival predictor of laryngeal cancer, including OS, DSS, and laryngeal preservation.

Value of markers of systemic inflammation for the prediction of postoperative progression in patients with pancreatic neuroendocrine tumors.

Non-invasive prognostic predictors for rare pancreatic neuroendocrine tumors (PNETs) are lacking. We aimed to approach the prognostic value of preoperative systemic inflammatory markers in patients with PNETs. The clinical data of 174 patients with PNETs undergoing surgical treatment were retrospectively analyzed to explore the correlation of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and platelet to white blood cell ratio (PWR) with clinicopathological parameters and the progression of tumor after the operation. The optimal cutoff values for predictors and the area under the curve (AUC) of the receiver operating characteristic (ROC) were estimated. Univariate and multivariate Cox proportional hazards models were used to assess the relation between NLR, LMR, PLR, and progression-free survival (PFS), examined by the Kaplan-Meier and log-rank tests. The scores of the NLR (P = 0.039) and PLR (P = 0.011) in the progression group were significantly higher than those in the progression-free group, and the LMR was significantly lower than those in the progression-free group (P = 0.001). The best cutoff values of NLR, LMR, and PLR before operation were 2.28, 4.36, and 120.91. The proportions of tumor progression in the high NLR group (P = 0.007) and high PLR group (P = 0.013) obviously increased, and the proportion of tumor development in the low LMR group was higher than that in the high LMR group (P < 0.001). The K-M survival curve showed that the progression-free survival rate was lower in the high NLR group (P = 0.004), the low LMR group (P < 0.001), and the high PLR group (P = 0.018). The results of the multivariate Cox proportional hazards model suggested that preoperative LMR (HR = 3.128, 95% CI: 1.107~8.836, P = 0.031) was an independent predictor of PFS. The markers of systemic inflammation, especially LMR, can predict the postoperative progression of PNETs.

Low prognostic nutrition index as a prognostic biomarker in elderly patients with early gastric cancer after gastrectomy.

Purpose Non-invasive biomarkers including systemic inflammatory or nutrition-based index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) can be useful in determining treatment strategies for elderly patients with early gastric cancer (EGC). The aim of this study was to investigate the significance of these index for predicting the long-term survival of EGC patients aged 80 years over. Methods This study included 80 elderly EGC patients with pStageIA after gastrectomy. Optimal cutoff value for PNI, NLR, PLR and LMR were set by using receiver operating curve analysis. The long-term outcomes after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. Results Cut-off value for PNI, NLR, PLR and LMR was set at 46.5, 2.8, 210 and 4.6, respectively. By univariate analyses, low PNI, high NLR, high PLR and low LMR were significantly associated with worse prognosis. By multivariate analysis, low PNI was confirmed as an independent prognostic factor after gastrectomy (HR 0.17 ; 95% CI 0.03-0.91 ; P = 0.04). 5-year overall survival rate of patients with low PNI (≤ 46.5) were 52.4%. Conclusion Low PNI might be useful biomarker to predict worse prognosis of elderly EGC patients after gastrectomy. J. Med. Invest. 71 : 113-120, February, 2024.

Preoperative Inflammation-Associated Blood Cell Markers in Patients with Non-Metastatic Clear Cell Renal Cell Carcinoma: A Retrospective Study.

This study aimed to investigate the association between preoperative inflammation-associated blood cell markers and the prognosis of patients with non-metastatic clear cell renal cell carcinoma (ccRCC) who underwent nephrectomy. We retrospectively analyzed data from our single-center cohort of patients who underwent radical or partial nephrectomy for non-metastatic ccRCC. The optimal cutoff values for red blood cell distribution width (RDW), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) were determined using X-tile software. We evaluated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) using the Kaplann-Meier method. Cox proportional-hazards regression models were utilized to assess predictors of RFS, CSS, and OS. The predictive accuracy was evaluated using Harrell's Concordance Index (C-index). A total of 444 patients who underwent nephrectomy were included in the study. The optimal cutoff values for RDW, PLR, NLR, and LMR were determined as 13.1, 157.3, 3.4, and 2.7, respectively. On univariate Cox regression analysis, NLR, PLR, and LMR were significant predictors for RFS, CSS, and OS. After adjusting for important prognostic factors, only NLR remained a significant prognostic marker for both CSS and OS. When NLR was added to the stage, size, grade, and necrosis (SSIGN) model, the C-index increased from 0.777 to 0.826 for CSS and from 0.703 to 0.734 for OS. Similarly, when NLR was added to the University of California, Los Angeles, Integrated Staging System (UISS), the C-index increased from 0.796 to 0.811 for CSS and from 0.735 to 0.745 for OS. NLR is a reliable prognostic biomarker for patients with non-metastatic ccRCC. The prognostic capabilities of UISS and SSIGN models could be improved by adding NLR to UISS and SSIGN models.

Lymphocyte-to-monocyte ratio after primary surgery is an independent prognostic factor for patients with epithelial ovarian cancer: A propensity score matching analysis.

The aim of this study was to elucidate the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR) after primary surgery in epithelial ovarian cancer (EOC) patients using a propensity score matching (PSM) analysis. We retrospectively reviewed consecutive EOC patients who underwent primary surgery between January 2008 and December 2019. Patients were divided into two groups according to the optimal cutoff value of preoperative LMR. PSM (1:1) was conducted to eliminate confounding factors. A Cox proportional hazards model and the Kaplan-Meier estimator were employed to investigate the potential prognostic factors. A total of 368 EOC patients were included in this study. The optimal cutoff value of LMR was identified as 4.65. Low preoperative LMR was significantly correlated with low albumin, high CA125 level, more blood loss, a high likelihood of ascites, advanced FIGO stage, and poor differentiation (all p < 0.05). After matching, Kaplan-Meier curves showed that the group with LMR < 4.65 experienced significantly shorter OS (p = 0.015). Multivariate Cox analysis revealed that low LMR (HR = 1.49, p = 0.041), advanced FIGO stage (HR = 5.25, p < 0.001), and undefined residual disease (HR = 3.77, p = 0.002) were independent factors in predicting poor OS. A forest plot revealed that LMR had better prognostic value in younger EOC patients, patients with BMI ≥ 25 kg/m2 and albumin ≥ 35 g/L, CA125 ≥ 35 U/L, patients who had undergone optimal surgery, and those who had completed chemotherapy. Additionally, low-LMR patients who had undergone incomplete chemotherapy had a shorter median OS compared with those who completed chemotherapy treatment (48.5 vs. 105.9 months, p = 0.026). LMR could be used as an independent prognostic factor for EOC patients after primary surgery; a noticeable negative effect of LMR was observed among EOC patients with age < 65, good preoperative nutritional status, and more aggressive tumor biology, and among those who underwent optimal surgery. Completing adjuvant chemotherapy is essential to improve survival outcomes among EOC patients with LMR < 4.65 after surgery.

The predictive value of lymphocyte to monocyte ratio for overall survival in cholangiocarcinoma patients with hepatic resection.

There is considerable heterogeneity in clinical behavior and survival outcomes in patients with cholangiocarcinoma (CCA), and the prognosis of CCA patients is poor. We proposed lymphocyte to monocyte ratio (LMR) as a novel prognostic element for CCA patients with hepatic resection in present study. By retrospectively analyzing the clinical data of 145 CCA patients with hepatic resection, we determined the optimal LMR cutoff value according to the receiver operating characteristic (ROC). We comparatively analyzed the clinical features of CAA patients between low LMR group and high LMR group, mainly including overall survival (OS) analysis by using the Kaplan-Meier method, univariate and multivariate Cox regression. We found there was a longer OS in CCA patients of the high LMR group than the low LMR group. The total median OS of cholangiocarcinoma patients were 13.6 months, and the OS of low LMR group was markedly lower than the high LMR group. The 1-year, 3-year, and 5-year OS of high LMR group were respectively 62.9%, 32.4%, and 16.4%, and were significantly higher the cholangiocarcinoma patients of low LMR group (40.2%, 16.4%, and 0%). Multivariate regression analyses showed that preoperative cholangitis, elevated CEA level and nerve invasion were risk factors for the OS of cholangiocarcinoma patients, while the high LMR level and postoperative treatment were protective factors for the OS of cholangiocarcinoma patients. Preoperative LMR was a vital prognostic factor to predict the prognosis of CCA patients with hepatic resection and provided additional prognostic value beyond standard clinicopathological parameters.

Systemic immune inflammation index and peripheral blood carbon dioxide concentration at admission predict poor prognosis in patients with severe traumatic brain injury.

Recent studies have shown that systemic inflammation responses and hyperventilation are associated with poor outcomes in patients with severe traumatic brain injury (TBI). The aim of this retrospective study was to investigate the relationships between the systemic immune inflammation index (SII = platelet × neutrophil/lymphocyte) and peripheral blood CO2 concentration at admission with the Glasgow Outcome Score (GOS) at 6 months after discharge in patients with severe TBI. We retrospectively analyzed the clinical data for 1266 patients with severe TBI at three large medical centers from January 2016 to December 2021, and recorded the GOS 6 months after discharge. The receiver operating characteristic (ROC) curve was used to determine the best cutoff values for SII, CO2, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR), and chi-square tests were used to evaluate the relationships among SII, CO2 and the basic clinical characteristics of patients with TBI. Multivariate logistic regression analysis was used to determine the independent prognostic factors for GOS in patients with severe TBI. Finally, ROC curve, nomogram, calibration curve and decision curve analyses were used to evaluate the value of SII and coSII-CO2 in predicting the prognosis of patients with severe TBI. And we used the multifactor regression analysis method to build the CRASH model and the IMPACT model. The CRASH model included age, GCS score (GCS, Glasgow Coma Scale) and Pupillary reflex to light: one, both, none. The IMPACT model includes age, motor score and Pupillary reflex to light: one, both, none. The ROC curves indicated that the best cutoff values of SII, CO2, PLR, NLR and LMR were 2651.43×109, 22.15mmol/L, 190.98×109, 9.66×109 and 1.5×109, respectively. The GOS at 6 months after discharge of patients with high SII and low CO2 were significantly poorer than those with low SII and high CO2. Multivariate logistic regression analysis revealed that age, systolic blood pressure (SBP), pupil size, subarachnoid hemorrhage (SAH), SII, PLR, serum potassium concentration [K+], serum calcium concentration [Ca2+], international normalized ratio (INR), C-reactive protein (CRP) and co-systemic immune inflammation index combined with carbon dioxide (coSII-CO2) (P < 0.001) were independent prognostic factors for GOS in patients with severe TBI. In the training group, the C-index was 0.837 with SII and 0.860 with coSII-CO2. In the external validation group, the C-index was 0.907 with SII and 0.916 with coSII-CO2. Decision curve analysis confirmed a superior net clinical benefit with coSII-CO2 rather than SII in most cases. Furthermore, the calibration curve for the probability of GOS 6 months after discharge showed better agreement with the observed results when based on the coSII-CO2 rather than the SII nomogram. According to machine learning, coSII-CO2 ranked first in importance and was followed by pupil size, then SII. SII and CO2 have better predictive performance than NLR, PLR and LMR. SII and CO2 can be used as new, accurate and objective clinical predictors, and coSII-CO2, based on combining SII with CO2, can be used to improve the accuracy of GOS prediction in patients with TBI 6 months after discharge.

Prognostic value of preoperative systemic inflammatory response as a prognostic indicator in patients with early-stage oral squamous cell carcinoma.

To determine the usefulness of lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and inflammatory response biomarker (IRB) score for predicting disease-specific survival and delayed cervical lymph node metastasis in early-stage oral squamous cell carcinoma (OSCC). We retrospectively analyzed 72 patients with early-stage OSCC. Receiver operating characteristic curve analysis was used to determine the cutoff values for LMR, NLR, and PLR. IRB score was determined as follows: high LMR, high NLR, and low PLR, which were each rated as 1. These scores were added to obtain IRB score (range: 0-3). From univariate analysis, gender, poor mode of invasion, and high IRB score were identified as significant risk factors for disease-specific survival. However, there were no independent factors for poor prognosis in multivariate analysis. On the other hand, for delayed cervical lymph node metastasis, poor mode of invasion, low LMR, high NLR, high PLR, and high IRB score were identified as significant risk factors from univariate analysis, and in multivariate analysis, poor mode of invasion and high IRB score were confirmed as independent risk factors. IRB score and mode of invasion are potentially independent risk factors for delayed cervical lymph node metastasis in early-stage OSCC.

Prognostic importance of the preoperative New-Naples prognostic score for patients with gastric cancer.

The wide applicability of the Naples prognostic score (NPS) is still worthy of further study in gastric cancer (GC). This study aimed to construct a New-NPS based on the differences in immunity and nutrition in patients with upper and lower gastrointestinal tumors to help obtain an individualized prediction of prognosis. This study retrospectively analyzed patients who underwent radical gastrectomy from April 2014 to September 2016. The cutoff values of the preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin (Alb), and total cholesterol (TC) were calculated by ROC curve analysis. ROC and t-ROC were used to evaluate the accuracy of the prognostic markers. The Kaplan-Meier method and log-rank test were used to analyze the overall survival probability. Univariate and multivariate analyses based on Cox risk regression were used to show the independent predictors. The nomogram was made by R studio. The predictive accuracy of nomogram was assessed using a calibration plot, concordance index (C-index), and decision curve. A total of 737 patients were included in training cohort, 411 patients were included in validation cohort. ROC showed that the New-NPS was more suitable for predicting the prognosis of GC patients. NPS=2 indicated a poor prognosis. Multivariate analysis showed that CEA (P=0.026), Borrmann type (P=0.001), pTNM (P < 0.001), New-NPS (P < 0.001), and nerve infiltration (P=0.035) were independent risk factors for prognosis. The New-NPS based on the cutoff values of NLR, LMR, Alb, and TC is not only suitable for predicting prognosis but can also be combined with clinicopathological characteristics to construct a nomogram model for GC patients.

The prognostic value of admission lymphocyte-to-monocyte ratio in critically ill patients with acute myocardial infarction

BackgroundInflammation plays a critical role in acute myocardial infarction (AMI). Recent studies have shown the value of hematologic indicators in MI risk stratification and prognostic assessment. However, the association between lymphocyte-to-monocyte ratio (LMR) and the long-term mortality of critically ill MI patients remains unclear.MethodsClinical data were extracted from the Medical Information Mart for Intensive Care III database. Patients diagnosed with AMI on admission in the intensive care units were include. The optimal cutoff value of LMR was determined by X-tile software. The Cox proportional hazard model was applied for the identification of independent prognostic factors of 1-year mortality and survival curves were estimated using the Kaplan–Meier method. In order to reduce selection bias, a 1:1 propensity score matching (PSM) method was performed.ResultsA total of 1517 AMI patients were included in this study. The cutoff value for 1-year mortality of LMR determined by X-Tile software was 3.00. A total of 534 pairs of patients were matched after PSM. Multivariate analysis (HR = 1.369, 95%CI 1.110–1.687, P = 0.003) and PSM subgroups (HR = 1.299, 95%CI 1.032–1.634, P = 0.026) showed that 1-year mortality was significantly higher in patients with LMR < 3.00 than patients with LMR ≥ 3.00 in Cox proportional hazard models. The survival curves showed that patients with LMR < 3.00 had a significantly lower 1-year survival rate before (63.83 vs. 81.03%, Log rank P < 0.001) and after PSM (68.13 vs. 74.22%, Log rank P = 0.041).ConclusionIn this retrospective cohort analysis, we demonstrated that a low admission LMR (< 3.00) was associated with a higher risk of 1-year mortality in critically ill patients with AMI.

Preoperative inflammatory markers for predicting parathyroid carcinoma.

ObjectiveParathyroid carcinoma is a rare tumor among parathyroid tumors. Aspiration cytology and needle biopsy are generally not recommended for diagnostic purposes because they cause dissemination. Therefore, it is commonly diagnosed by postoperative histopathological examination. In this study, we investigated whether preoperative inflammatory markers can be used as predictors of cancer in patients with primary hyperparathyroidism.DesignThis was a retrospective study.MethodsThirty-six cases of parathyroid carcinoma and 50 cases of parathyroid adenoma (PA) operated with the diagnosis of primary hyperparathyroidism and confirmed histopathologically at Ito Hospital were included in this study. Preoperative clinical characteristics and inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR)) were compared and their values in preoperative prediction were evaluated and analyzed.ResultsPreoperative intact-parathyroid hormone (P = 0.0003), serum calcium (P = 0.0048), and tumor diameter (P = 0.0002) were significantly higher in parathyroid carcinoma than in PA. LMR showed a significant decrease in parathyroid carcinoma (P = 0.0062). In multivariate analysis, LMR and tumor length diameter were independent predictors. In the receiver operating characteristics analysis, the cut-off values for LMR and tumor length diameter were 4.85 and 28.0 mm, respectively, for parathyroid cancer prediction. When the two extracted factors were stratified by the number of factors held, the predictive ability improved as the number of factors increased.ConclusionIn the preoperative evaluation, a combination of tumor length diameter of more than 28 mm and LMR of less than 4.85 was considered to have a high probability of cancer.

Prognostic Significance of NLR, PLR, LMR and Tumor Infiltrating T Lymphocytes in Patients Undergoing Surgical Resection for Hilar Cholangiocarcinoma.

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.

Lymphocyte to monocyte ratio in metastatic pancreatic ductal adenocarcinoma as a prognostic factor and its potential role in identifying a subset of patients with a favorable response to therapy.

4153 Background: Despite the most recent therapeutic achievements, pancreatic ductal adenocarcinoma (PDAC) is characterized by poor prognosis and response to treatments. Among the most investigated prognostic biomarkers, the lymphocyte to monocyte ratio (LMr) is gaining increasing interest in literature, mostly in hematological malignancies, breast cancer, bladder cancer, non-small cell lung cancer, colorectal cancer, and resected pancreatic adenocarcinoma. In these settings, a higher LMr allows identifying a subset of patients with a better prognosis. Our study aimed to evaluate the role of the LMr as a prognostic factor in patients affected by metastatic PDAC and to find a cut-off value able to identify a subset of patients with better prognosis and possibly susceptible to other therapeutic options. Methods: Data from 228 patients were collected retrospectively from 2014 to 2021. 175 from the Department of Medical Oncology of the University Hospital of Cagliari and 53 from the Oncology Clinic - University Hospital of Ospedali Riuniti of Ancona. All patients had metastatic PDAC and blood samples were collected before starting first-line chemotherapy. The cut-off value for LMr was calculated according to the ROC curves at 6, 12, and 18 months. Kaplan-Meier curves were then obtained for the evaluation of survivals. Finally, multivariate analysis was performed, taking into consideration the following prognostic factors: sex, ECOG-PS, NL ratio, metastatic sites, Ca19.9 and LDH. Results: The median age was 68 y.o. (range 39-84 y.o.), 123 (54%) were males. Cut off value obtained for LMR, was 4. 156 (68,4%) patients had an LMr &lt; 4 and 72 (31,6%) patients had an LMR ≥ 4. Patients with a ratio ≥ 4 showed a statistically significant difference in terms of median overall survival compared to patients with a ratio &lt; 4 (23 months versus 11 months, p &lt; 0.0001). First-line median progression-free survival was also different in patients with a value greater than or equal to 4 (11 months versus 6 months, p = 0.005), suggesting a better treatment response in the first group of patients. Finally, multivariate analysis showed that LMR ≥ 4 is an independent prognostic factor for OS ( p = 0.0005). Conclusions: The results of our study show that the lymphocyte to monocyte ratio could be an important prognostic factor in patients with metastatic pancreatic ductal adenocarcinoma, although the limitations of a retrospective study should be considered. Furthermore, these findings suggest the active role of the immune response in limiting disease progression, indicating a group of patients who could benefit most from a target or combined immunotherapy treatment.

Preoperative Lymphocyte-to-Monocyte Ratio Can Indicate the Outcomes in Repair of I-III Degree Injury of Lateral Ankle Ligament.

Background This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results 178 patients (178 ankles) were followed up successfully, with a follow-up of 2.82 ± 1.54 years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with preoperative LMR < 3.824 were significantly lower than that of patients with preoperative LMR ≥ 3.824. The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.

Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with advanced oral cavity cancer.

IntroductionLymphocyte‐to‐monocyte ratio (LMR) has been reported as a prognostic factor in many cancers but the data are to date limited for its use in oral cavity cancer. The purpose of this study was to evaluate the prognostic value of LMR in advanced‐stage oral cavity cancer.MethodsData from 211 advanced‐stage oral cancer patients treated with curative intent between January 2009 and December 2015 were obtained from the hospital information system. Pretreatment LMR and other hematologic parameters were recorded and an LMR cutoff value was calculated. Overall survival between the groups above (high LMR) and below (low LMR) the cutoff was compared and hazard ratios from univariate and multivariate analyses using a Cox proportional hazards model calculated.ResultsOverall survival and disease‐specific survival were better in the high LMR group. The 5‐year overall survival rates were 31.6% and 15% in the high LMR and low LMR groups, respectively. Multivariate analysis using a Cox proportional hazards model showed that treatment modality and LMR were the only factors associated with overall survival.ConclusionLow LMR was associated with poor survival outcome in patients with advanced‐stage oral cavity cancer.Level of Evidence2b.

The Pretreatment Systemic Inflammation Response Index as a Useful Prognostic Factor is Better Than Lymphocyte to Monocyte Ratio in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

It has been reported that the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR), as well as systemic inflammation response index (SIRI), are closely related with overall survival (OS) in breast cancer patients. However, which one is the optimal indicator is vague. This study incorporates 280 breast cancer patients who received NACT. A cut-off value of LMR, PLR, SIRI and NLR is determined by Youden index. The Pearson's X2 test or Fisher's exact test is applied to compare the correlation of different clinicopathologic characteristics divided by SIRI. The K-M survival curves and log-rank test were applied to determine OS. Univariate and multivariable analysis are explored by the Cox regression model. We apply the Z test to contrast the prognostic capacity of SIRI, LMR, PLR, and NLR. At the meanwhile, we construct the nomogram based on the results of multivariable analysis. All enrolled cases are divided into two parts by pretreatment SIRI (cut-off value = 0.52). Compared to high pre-treatment SIRI, high pre-treatment NLR and clinical T3 + T4 stage, the low pre-treatment SIRI, low pretreatment NLR and clinical T1 + T2 stage had longer OS time. The Z test showed that the SIRI group had bigger AUC than LMR and PLR, and the difference is statistically significant. The ability of nomogram, based on pretreatment SIRI, pre-treatment NLR and clinical T stage, to predict the 3-year, 5-year, and 8-year overall survival rates of breast malignant tumor patients is better than clinical TNM stage. Pre-treatment SIRI was a more crucial and integral prognostic index for breast malignant tumor patients receiving NACT. It could be helpful for doctors to predict the prognosis of breast malignant tumor patients and to evaluate the treatment status of patients.

Utility of Blood Markers for Predicting Outcomes of Fertility Preservation in Patients With Breast Cancer.

This study aimed to investigate the usability of blood markers for predicting controlled ovarian stimulation (COS) outcomes in patients with breast cancer undergoing fertility preservation (FP). In total, 91 patients with breast cancer who had undergone COS using a letrozole-combined gonadotropin-releasing hormone (GnRH) antagonist protocol before chemotherapy were enrolled retrospectively in a single tertiary hospital. FP outcomes were compared in terms of the mean platelet volume (MPV), MPV/platelet count (PC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). The cutoff values for obtaining 10 or more mature oocytes as favorable prognoses were obtained for each parameter, and the COS outcomes were compared based on the cutoff values. The optimal cutoff levels for MPV and MPV/PC were 10.15 [sensitivity: 90.0%; specificity: 45.1%; AUC: 0.687; 95% CI (0.563, 0.810)] and 0.41 [sensitivity: 65.0%; specificity: 67.6%; AUC: 0.682; 95% CI (0.568, 0.796)], respectively. The oocyte numbers did not significantly differ with respect to the cutoff values of NLR, PLR, and LMR (p > 0.05). However, the total number of acquired and mature oocytes were significantly lower in the group with MPV<10.15 than in that with MPV≥10.15 (8.0 ± 5.1 vs. 12.6 ± 9.1, p=0.003; 4.0 ± 3.7 vs. 7.3 ± 6.3, p=0.002, respectively). Similarly, considering the cutoff of MPV/PC as 0.41, the low-MPV/PC group showed a significantly lower total oocyte yield than the high-MPV/PC group (9.5 ± 7.1 vs. 13.1 ± 9.1, p=0.048), whereas the number of mature oocytes showed similar patterns with no statistical significance (5.3 ± 5.4 vs. 7.3 ± 6.1, p=0.092). From logistic regression analysis, age, anti-Müllerian hormone (AMH) level, MPV, and MPV/PC≥0.41 were found to be significant factors for the acquisition of 10 or more MII oocytes (p=0.049, OR: 0.850; p<0.001, OR: 1.622; p=0.018, OR: 3.184; p=0.013, OR: 9.251, respectively). MPV or MPV/PC can be a reliable marker for predicting FP outcome in patients with breast cancer. Protocols to acquire more mature oocytes, such as the dual-trigger approach, could be recommended for patients with breast cancer with MPV<10.15. Furthermore, a higher dose of gonadotropins was considered to obtain more oocytes in patients with MPV/PC<0.41.

Predictive value of lymphocyte-to-monocyte ratio in critically Ill patients with atrial fibrillation: A propensity score matching analysis.

BackgroundInflammation plays a key role in the initiation and progression of atrial fibrillation (AF). Lymphocyte‐to‐monocyte ratio (LMR) has been proved to be a reliable predictor of many inflammation‐associated diseases, but little data are available on the relationship between LMR and AF. We aimed to evaluate the predictive value of LMR in predicting all‐cause mortality among AF patients.MethodsData of patients diagnosed with AF were retrieved from the Medical Information Mart for Intensive Care‐III (MIMIC‐III) database. X‐tile analysis was used to calculate the optimal cutoff value for LMR. The Cox regression model was used to assess the association of LMR and 28‐day, 90‐day, and 1‐year mortality. Additionally, a propensity score matching (PSM) method was performed to minimize the impact of potential confounders.ResultsA total of 3567 patients hospitalized with AF were enrolled in this study. The X‐tile software indicated that the optimal cutoff value of LMR was 2.67. A total of 1127 pairs were generated, and all the covariates were well balanced after PSM. The Cox proportional‐hazards model showed that patients with the low LMR (≤2.67) had a higher 1‐year all‐cause mortality than those with the high LMR (>2.67) in the study cohort before PSM (HR = 1.640, 95% CI: 1.437–1.872, p < 0.001) and after PSM (HR = 1.279, 95% CI: 1.094–1.495, p = 0.002). The multivariable Cox regression analysis for 28‐day and 90‐day mortality yielded similar results.ConclusionsThe lower LMR (≤2.67) was associated with a higher risk of 28‐day, 90‐day, and 1‐year all‐cause mortality, which might serve as an independent predictor in AF patients.