Low Lymphocyte-to-monocyte Ratio Group Research Articles

Prognostic Role of Lymphocyte-to-Monocyte Ratio (LMR) in Patients with Intermediate-Stage Hepatocellular Carcinoma (HCC) Undergoing Chemoembolizations (DEM-TACE or cTACE) of the Liver: Exploring the Link between Tumor Microenvironment and Interventional Radiology.

Inflammation-based scores are biomarkers of the crosstalk between the tumor microenvironment and the immune response. Investigating the intricate relationship between the tumor stromal microenvironment, biomarkers, and the response to transcatheter arterial chemoembolization (TACE) is essential for early identification of TACE refractoriness or failure, providing insights into tumor biology and facilitating personalized therapeutic interventions. This study addresses a dearth of recent literature exploring the prognostic significance of the preoperative LMR in individuals from western countries diagnosed with stage B hepatocellular carcinoma (HCC) undergoing drug eluting microspheres TACE (DEM-TACE) or conventional TACE (cTACE). This international multi-center retrospective analysis included consecutive patients with stage B HCC who underwent TACE from January 2017 to June 2023. The study evaluated the ability of the preoperative LMR to predict complete response (CR), objective response (OR), sustained response duration (SRD) exceeding 6 months, successful downstaging at 6 months, progression-free survival (PFS) at 6 months, and overall survival (OS) at 6 months. The study population included 109 HCC patients and it was divided into low LMR (LMR < 2.24) and high LMR (LMR ≥ 2.24) groups, according to ROC curve analysis to select the optimal LMR cut-off value. High LMR was associated with lower Hepatitis C prevalence, higher absolute lymphocyte count, and a trend toward lower alpha-fetoprotein. The group with high LMRs exhibited superior CR rates (14.9% vs. 0%), overall OR (43.2% vs. 14.3%), and better PFS at 6 months (75.7% vs. 45.7%). The LMR, specifically categorized as <2.24 and ≥2.24, emerged as a robust predictor for treatment response and short-term outcomes in patients with stage B HCC undergoing DEM- or c-TACE.

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.

Correlation between preoperative peripheral blood NLR, PLR, LMR and prognosis of patients with head and neck squamous cell carcinoma

BackgroundMarkers that can be used to evaluate the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) remain undefined.ObjectiveThis study aimed to investigate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in patients with HNSCC who underwent surgery-based treatment for the first time.MethodsThis retrospective study included patients HNSCC who underwent surgery-based treatment at our institution between January 2018 and December 2020. Specificity and sensitivity were analyzed using receiver operating characteristic (ROC) curves and the critical value was determined. Patients were divided into low and high groups according to NLR, PLR, and LMR the critical value. Log-rank and Cox proportional hazards models were used to evaluate the associations between preoperative NLR, PLR, LMR, and overall survival (OS).ResultsA total of 304 patients with HNSCC were included, of whom 190 (62.5%) and 114 (37.5%), 203 (66.8%) and 101 (33.2%), 98 (32.2%), and 206 (67.8%) cases were classified as low NLR and high NLR groups, low PLR and high PLR groups, and low LMR and high LMR groups, respectively. Univariate analysis showed that white blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), NLR, pathologic N stage (pN stage), TNM stage and postoperative complications were significantly associated with OS (p < 0.05). Multivariate analysis showed that NEU, NLR, TNM stage and postoperative complications were independent negative prognostic factors for HNSCC (p < 0.05).ConclusionPreoperative NLR is an independent negative prognostic factor for HNSCC. Patients with an increased NLR may have a poor OS.

227. RELATIONSHIP BETWEEN 90-DAY PROGNOSIS NUTRITIONAL INDEX AND INFLAMMATORY RESPONSE MARKERS AND LONG-TERM SURVIVAL IN ESOPHAGEAL CANCER

Abstract Background The incidence rate of esophageal cancer in Asia is mainly squamous cell carcinoma, which is characterized by high mortality and poor prognosis. The prognosis of tumors is not only related to the biological characteristics of tumor cells, but also closely related to the nutritional status and inflammatory response of patients. The aim of this study is to investigate the relationship between nutritional index (PNI) and inflammatory response markers (NLR, LMR) at 90 days after surgery and long-term survival in patients with esophageal squamous cell carcinoma. To provide reference for accurately assessing the condition, identifying survival risks, and improving long-term prognosis. Methods The data of ESCC patients who underwent radical resection for esophageal cancer from April 2018 to November 2018 were extracted (n = 66). Calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and other indicators of patients at 90 days after operation. ROC was used to calculate the cut-off values of PNI, NLR, and LMR. KaplanMeier survival curve was used to analyze the relationship between different PNI, NLR, LMR levels and long-term survival of patients. All patients were followed up regularly after surgery, and the last follow-up time was April 2023. Results The best cut-off values of PNI, NLR, and LMR were 42.8, 3.27, and 4.76, respectively. Kaplan Meier survival analysis showed a correlation between postoperative PNI, NLR, LMR at 90 days and overall survival and disease-free survival. At 90 days after surgery, the OS (P = 0.007) and DFS (P = 0.038) of patients in the high PNI group (PNI ≥ 42.8) were better than those in the low PNI group; The OS (P = 0.002) and DFS (P = 0.048) of patients in the low NLR group (NLR &amp;lt; 3.27) were better than those in the high NLR group; The OS (P = 0.001) and DFS (P = 0.039) of patients in the high LMR group (LMR ≥ 4.76) were better than those in the low LMR group. Conclusions PNI, NLR, and LMR are important predictors of OS and DFS in patients with esophageal squamous cell carcinoma after radical resection of esophagus. Patients with PNI ≥ 42.8, NLR&amp;lt;3.27, and LMR ≥ 4.76 at 90 days after surgery have better OS and DFS.

Influence of Pre-treatment Lymphocyte/Monocyte Ratio and Neutrophil/Lymphocyte Ratio on the Prognosis of Patients with Extranodal NK/T-Cell Lymphoma

To explore the influence of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) on the prognosis of patients with extranodal NK/T cell lymphoma (ENKTL). The clinical data of 203 patients with ENKTL admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were retrospectively analyzed. The ROC curve determined the limit values of LMR and NLR; Categorical variables were compared using a chi-square test, expressed as frequency and percentage (n,%). Continuous variables were expressed as medians and extremes and compared with the Mann-Whitney U test; Progression-free survival (PFS) and overall survival (OS) of different grouped LMR and NLR patients were analyzed using Kaplan-Meier curves and compared with log-rank tests. The COX proportional risk regression model was used to perform one-factor and multi-factor analysis of PFS and OS. The optimal critical values of LMR and NLR were determined by the ROC curve, which were 2.60 and 3.40, respectively. LMR≤2.60 was more likely to occur in patients with bone marrow invasion (P=0.029) and higher LDH (P=0.036), while NLR≥3.40 was more likely to occur in patients with higher ECOG scores (P=0.002), higher LDH (P=0.008), higher blood glucose (P=0.024), and lower PLT (P=0.010). Kaplan-Meier survival analysis showed that PFS and OS of patients in the high LMR group were significantly better than the low LMR group, while PFS and OS in the low NLR group were significantly better than the high NLR group. The results of multivariate COX analysis showed that EBV-DNA positive (P=0.047), LMR≤2.60 (P=0.014), NLR≥3.40 (P=0.023) were independent risk factors affecting PFS in patients with ENKTL. LMR≤2.60 (P<0.001), NLR≥3.40 (P=0.048), and high β2-MG (P=0.013) were independent risk factors affecting OS in patients with ENKTL. Low LMR and high NLR before treatment are associated with poor prognosis in patients with ENKTL, which also can be used as an easily testable, inexpensive, and practical prognostic indicator in the clinic.

The prognostic role of lymphocyte to monocyte ratio (LMR) in patients with Myelodysplastic Neoplasms

ABSTRACTBackground:Previous studies validated the prognostic significance of lymphocyte to monocyte ratio (LMR) in patients with solid tumors and some hematologic malignancies. However, the correlation between LMR and Myelodysplastic Neoplasms (MDS) was unclear. The study intends to investigate the prognostic impact of LMR on MDS patients.Methods:91 newly diagnosed MDS patients were included in this retrospective study. The cut-off of LMR was 3.2 by X-Tile. All patients were divided into the low LMR group (<3.2) and the high LMR group (≥3.2). Clinical characteristics were compared between the two groups.Results:Patients in the high LMR group (n = 67) had better OS (P = 0.007) from the Kaplan-Meier survival curves. The results of the univariate analysis demonstrated that LMR was a prognostic factor for OS [hazard ratio (HR) = 2.070, 95%CI 1.201-3.571, P = 0.009]. After multivariate cox analysis, low LMR was confirmed to be an independent predictor of poor OS in MDS patients (HR = 1.872, 95%CI 1.084-3.230, P = 0.024).Conclusions:LMR, a representative marker of systematic inflammation and immune response, has potential prognostic significance in MDS patients.

Prognostic Value of Lymphocyte-to-Monocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Patients with Colorectal Cancer: "A Retrospective Cohort Study"

Background: In the past decade, advancements in the treatment of colorectal cancer (CRC) have greatly improved survival; nevertheless, simple biomarkers to predict responsiveness to therapy or survival that seem relevant to all medical oncology settings globally have yet to be developed. The neutrophil/lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) are two simple and generally accessible examples of inflammation markers based on differential white cell counts. Methods: LMR and NLR were evaluated in 69 patients diagnosed with CRC and received different treatment approaches depending on the stage, ECOG, and treatment guidelines. The correlation between LMR and clinical pathology was retrospectively evaluated. The predicted values of NLR and compared the predicted values of LMR and NLR were also assessed. Results: After analyzing the receiver operating characteristic (ROC) curve, the cut-off level for LMR and NLR was determined to be 2. Out of the total patients, 55 (79.7%) were classified into the high LMR group, while 14 (20.3%) were categorized into the low LMR group. Among the patients, 30 (43.5%) and 39 (56.5%) were grouped into low and high NLR groups, respectively. It was concluded that tumor markers (CEA) (p 0.031), TNM staging (p=0.016), distant metastasis (p=0.014), and disease progression (p=0.038) were significant. NLR was significant in only tumor markers (p=0.014) and tumor location (p=0.046). OS was significant. Conclusion: The results indicate that prior to treatment, both LMR and NLR were significant independent predictors in colon cancer and that incorporating NLR/LMR alongside TNM staging may enhance prognostic evaluation in patients with colon cancer. However, the study was limited by a retrospective methodology and a relatively small sample size. To determine the exact cut-off values for NLR and LMR as prognostic indicators in colorectal cancer, larger-scale prospective studies involving multiple centers will be required.

Inflammatory biomarkers predict outcomes of patients with radioactive iodine refractory thyroid cancer treated with sorafenib.

The objective of this multicenter, retrospective cohort study was to evaluate the ability of inflammatory biomarkers representing the host immune system to predict outcomes in 70 patients with progressive radioactive iodine (RAI)-refractory thyroid cancer who were treated with sorafenib. Patients were divided into low and high inflammatory biomarker groups based on median values. Progression-free survival (PFS) and overall survival (OS) were assessed based on the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The median LMR, NLR, and PLR values were 3.4, 2.2, and 140.1, respectively. No significant differences were observed in baseline characteristics of high and low LMR, NLR and PLR groups. Median PFS values were 6.6 and 19.5 months in the low and high LMR groups, respectively (P < 0.001). Compared with the high NLR and PLR groups, PFS was significantly prolonged in the low NLR and PLR groups (P = 0.003 and P = 0.041 respectively). In the multivariate analysis, low LMR and high NLR were associated with poor PFS after adjusting for multiple confounding factors including age, sex, pathology, disease-related symptoms, serum thyroglobulin level, lung-only metastasis, cumulative RAI dose, time from diagnosis, and longer diameter of the target lesion (hazard ratio, HR = 2.42; 95% confidence interval, CI 1.25-4.71; P = 0.009, and HR = 2.09; CI, 1.06-4.14; P = 0.033, respectively). High LMR, low NLR, and low PLR were significantly associated with prolonged OS (P = 0.011, P = 0.023, and P = 0.007, respectively). Patients with at least one risk factors for inflammatory biomarkers presented a significantly lower PFS (HR 2.29; CI, 1.36-3.84; P = 0.003) and OS (HR 2.95; CI, 1.49-5.81; P = 0.006) than patients without any risk factor. Baseline inflammatory biomarkers successfully predicted PFS and OS in patients with progressive RAI-refractory thyroid cancer treated with sorafenib. These prognostic biomarkers might help arrive at appropriate clinical decisions regarding the use of sorafenib.

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.

Relationship between preoperative inflammatory indexes and prognosis of patients with rectal cancer and establishment of prognostic nomogram prediction model

Objective: To compare the prognostic evaluation value of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in rectal cancer patients. Nomogram survival prediction model based on inflammatory markers was constructed. Methods: The clinical and survival data of 585 patients with rectal cancer who underwent radical resection in the First Affiliated Hospital of Xi'an Jiao tong University from January 2013 to December 2016 were retrospectively analyzed. The optimal cut-off values of NLR, PLR, LMR, and SII were determined by the receiver operating characteristic (ROC) curve. The relationship between different NLR, PLR, LMR and SII levels and the clinic pathological characteristics of the rectal cancer patients were compared. Cox proportional risk model was used for univariate and multivariate regression analysis. Nomogram prediction models of overall survival (OS) and disease-free survival (DFS) of patients with rectal cancer were established by the R Language software. The internal validation and accuracy of the nomograms were determined by the calculation of concordance index (C-index). Calibration curve was used to evaluate nomograms' efficiency. Results: The optimal cut-off values of preoperative NLR, PLR, LMR and SII of OS for rectal cancer patients were 2.44, 134.88, 4.70 and 354.18, respectively. There was statistically significant difference in tumor differentiation degree between the low NLR group and the high NLR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative carcinoembryonic antigen (CEA) level between the low PLR group and the high PLR group (P<0.05). There was statistically significant difference in tumor differentiation degree between the low LMR group and the high LMR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative CEA level between the low SII group and the high SII group (P<0.05). The multivariate Cox regression analysis showed that the age (HR=2.221, 95%CI: 1.526-3.231), TNM stage (Ⅲ grade: HR=4.425, 95%CI: 1.848-10.596), grade of differentiation (HR=1.630, 95%CI: 1.074-2.474), SII level (HR=2.949, 95%CI: 1.799-4.835), and postoperative chemoradiotherapy (HR=2.123, 95%CI: 1.506-2.992) were independent risk factors for the OS of patients with rectal cancer. The age (HR=2.107, 95%CI: 1.535-2.893), TNM stage (Ⅲ grade, HR=2.850, 95%CI: 1.430-5.680), grade of differentiation (HR=1.681, 95%CI: 1.150-2.457), SII level (HR=2.309, 95%CI: 1.546-3.447), and postoperative chemoradiotherapy (HR=1.837, 95%CI: 1.369-2.464) were independent risk factors of the DFS of patients with rectal cancer. According to the OS and DFS nomograms predict models of rectal cancer patients established by multivariate COX regression analysis, the C-index were 0.786 and 0.746, respectively. The calibration curve of the nomograms showed high consistence of predict and actual curves. Conclusions: Preoperative NLR, PLR, LMR and SII levels are all correlated with the prognosis of rectal cancer patients, and the SII level is an independent prognostic risk factor for patients with rectal cancer. Preoperative SII level can complement with the age, TNM stage, differentiation degree and postoperative adjuvant chemoradiotherapy to accurately predict the prognosis of rectal cancer patients, which can provide reference and help for clinical decision.

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.

Significance of Lymphocyte-to-Monocyte Ratio and Corrected Levels of Serum Calcium as Prognostic Markers in Patients with Newly Diagnosed Multiple Myeloma

To investigate the significance of peripheral blood lymphocyte to monocyte ratio (LMR) and corrected levels of serum calcium (cCa) as prognostic markers for the newly diagnosed multiple myeloma (MM) patients. The clinical data of 114 newly diagnosed MM patients in the Second Affiliated Hospital of Kunming Medical University from January 2013 to March 2020 were retrospectively analyzed. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value, and the patients were divided into high LMR group and low LMR group (LMR≥3.35 and LMR < 3.35). Moreover, the patients were divided into four groups according to initial diagnosis LMR and LMR after four courses of treatment (LMR4): Group A (LMR≥3.35, LMR4≥3.35), Group B (LMR≥3.35, LMR4 < 3.35), Group C (LMR < 3.35, LMR4≥3.35), and group D (LMR < 3.35, LMR4 < 3.35). The simple prognosis model was established by combined with LMR and cCa, the patients were divided into Group a (no risk factor), group b (1 risk factor) and Group c (2 risk factors). Independent sample T-test, Pearson Chi-square test or Mann-Whitney U test were used to evaluate the differences between various parameters, and Kaplan-Meier method and Cox regression were used for survival analysis. The median follow-up time was 13.05（0.1-72.5）months. Survival analysis showed that the patients with low LMR predicted poor prognosis, the overall survival (OS) time of the patients with low LMR was significantly shorter (17 vs 50.5 months, P=0.006) than the patients with high LMR, the difference was also significant between group A and Group D (56.5 vs 30.5 months, P=0.043). The OS of the patients was also significantly shorter in the high cCa group (≥2.75 mmol/L) compared with normal group (8.5 vs 34 months, P=0.006). Multivariate survival analysis showed that LMR < 3.35 (P=0.028) and cCa≥2.75 mmol/L (P=0.036) were the independent risk factors affecting prognosis of MM patients. The comparison of risk factors showed that the median OS of Group a, b and c was 50, 20, and 8.5 months, respectively. The prognosis of the patients without risk factors was better than that of patients with 1-2 risk factors (Group a vs Group b, P < 0.0001; Group a vs Group c, P=0.002). LMR and cCa are the independent risk factors affecting the prognosis of newly diagnosed MM patients, and the development of a simple prognosis system combining them can quickly identify the prognosis of newly diagnosed MM patients.

Prognostic Value of Lymphocyte-to-Monocyte Ratio for Japanese Patients With Differentiated Thyroid Cancer Treated With Sorafenib Therapy.

We investigated the efficacy and safety of sorafenib in Japanese patients and the prognostic value of systemic immunity markers for predicting clinical outcomes after sorafenib therapy in patients with radioiodine refractory differentiated thyroid cancer (RR-DTC). We retrospectively evaluated 26 patients with RR-DTC who underwent sorafenib therapy between July 2014 and December 2020. The systemic immunity markers were calculated from blood cell counts. The median overall survival (OS) was 2,002 days, and the clinical benefit rate was 80.8%. The high lymphocyte-to-monocyte ratio (LMR) group had significantly longer OS than the low LMR group (hazard ratio=0.21; 95% confidence interval=005-0.88; log-rank p=0.019). Adverse events observed in this study were acceptable, and no new safety signals associated with sorafenib were found. Sorafenib therapy is efficacious and safe for Japanese patients with RR-DTC, and baseline LMR may be useful as a sorafenib therapy prognostic marker.

Predictive Value of a Prognostic Model Based on Lymphocyte-to-Monocyte Ratio Before Radioiodine Therapy for Recurrence of Papillary Thyroid Carcinoma.

Background:The aim of this study was to investigate the predictive value of a prognostic model based on the lymphocyte-to-monocyte ratio (LMR) before radioiodine treatment for the recurrence of papillary thyroid carcinoma (PTC).Methods:Clinicopathological data of 441 patients with papillary thyroid cancer were collected retrospectively. The Receiver operating characteristic (ROC) was used to determine the optimal cut-off value for predicting PTC recurrence by LMR before radioiodine treatment. Recurrence was the endpoint of the study, and survival was estimated by the Kaplan-Meier method, and any differences in survival were evaluated with a stratified log-rank test. Univariate and multifactorial analyses were performed using Cox proportional-hazards models to identify risk factors associated with PTC recurrence.Results:The ROC curve showed that the best cut-off value of LMR before radioiodine treatment to predict recurrence in patients with PTC was 6.61, with a sensitivity of 54.1%, a specificity of 73%, and an area under the curve of 0.628. The recurrence rate was significantly higher in the low LMR group (16%) than in the high LMR group (5%) (P = 0.001, χ2 = 12.005). Multifactorial analysis showed that LMR < 6.61 (P = 0.006; HR = 2.508) and risk stratification (high risk) (P = 0.000; HR = 5.076) before radioiodine treatment were independent risk factors predicting recurrence in patients with PTC. Patients with preoperative LMR < 6.61 and high risk stratification had the lowest recurrence-free survival rate and the shortest recurrence-free survival time.Conclusions:The LMR-based prognostic model before radioactive iodine treatment is valuable for early prediction of PTC recurrence and it can be used in clinical practice as a supplement to risk stratification and applied in combination to help screen out patients with poorer prognosis early.

Comparison of lymphocyte-to-monocyte ratio with Child-Pugh and PELD/MELD scores to predict the outcome of children with cirrhosis.

Aim of the studyPrognostic scores are highly needed to properly manage children with cirrhosis and improve their clinical outcomes. The relationship between lymphocyte-to-monocyte ratio (LMR) at the time of admission to hospital and outcome of cirrhosis has been studied in adults, but to the best of our knowledge, there is no study regarding its utility as a prognostic marker of poor outcome in children with cirrhosis. Thus, this study aimed to investigate the potential prognostic value of LMR in such patients.Material and methodsAt the time of admission, LMR, Child-Pugh, and Pediatric End-stage Liver Disease/Model for End-stage Liver Disease (PELD/MELD) scores were calculated for 114 children with cirrhosis. LMR and PELD/MELD and Child-Pugh scores were compared between the survivor and non-survivor groups. Receiver operator characteristic (ROC) curve analysis was performed and the cutoff values were calculated using the Youden index.ResultsIt was found that LMR had a strong negative correlation with PELD/MELD (r = –0.87, p = 0.36) and a weak negative correlation with Child-Pugh scores (r = –0.046, p = 0.63). The highest area under the curve (AUC) was found for LMR (0.861). The AUC was also good for PELD/MELD scores (0.804). The AUC values for LMR in patients under and above 6 years old were 0.675 (95% CI: 0.462-0.888) (p = 0.111) and 0.926 (95% CI: 0.852-1.000) (p < 0.001), respectively. The PELD/MELD scores were significantly higher in the low LMR group than in the high LMR group (p = 0.001).ConclusionsLMR can be used to determine the outcome of cirrhotic children older than 6 years during the hospital stay because it is easy to calculate and its efficacy is comparable to PELD/MELD scores. Meanwhile, further studies are needed to confirm these preliminary results.

Prognostic value of lymphocyte-to-monocyte ratio and systemic immune-inflammation index in non-small-cell lung cancer patients with brain metastases.

Aim: We aimed to evaluate the prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) in patients with brain metastases from non-small-cell lung cancer (NSCLC). Materials & methods: We conducted Kaplan-Meier analysis and multivariable Cox analysis to evaluate the prognostic values of NLR, PLR, LMR and SII. Results: Kaplan-Meier analysis showed that the patients in low LMR, high NLR, PLR and SII groups were associated with shorter overall survival. Multivariable Cox analysis revealed LMR and SII were independent prognostic factors for overall survival (p = 0.002 and p = 0.004, respectively). Conclusion: LMR and SII are of significant values in clinical prognostic evaluation for patients with brain metastases from NSCLC.

The relationships between systemic cytokine profiles and inflammatory markers in colorectal cancer and the prognostic significance of these parameters

BackgroundImmunomodulatory cytokines and systemic inflammatory markers are important during cancer development and progression. This study investigated the association and prognostic impact of systemic cytokine profiles and inflammatory markers in colorectal cancer (CRC).MethodsInterleukin (IL)-1β, IL-6, IL-8, IL-9, IL-10, tumour necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF) serum levels were measured using multiplex bead assays in CRC patients. Data on systemic inflammatory markers, such as the modified Glasgow prognostic score (mGPS), the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI) and fibrinogen, were collected. Survival analysis was performed to identify factors associated with progression-free survival (PFS) and overall survival (OS).ResultsThere were moderate-to-strong correlations within serum cytokines, as well as within systemic inflammatory markers, whereas the associations between serum cytokines and systemic inflammatory markers were generally weak. IL-8 and the LMR were independent significant prognostic factors for PFS and OS. The low IL-8 and high LMR group had the best survival (both PFS and OS) of all groups.ConclusionsSystemic cytokine profiles and inflammatory markers have relatively weak intergroup correlations. A composite classification of systemic cytokine profiles and inflammatory markers has an enhanced prognostic value in CRC.

Could ratio of hemoglobin to red cell distribution width and ratio of absolute lymphocyte count to absolute monocyte count be a prognostic tool in newly diagnosed multiple myeloma patients?

AbstractIntroductionHemoglobin/red cell distribution width (RDW) ratio (HRR) and lymphocyte-to-monocyte ratio (LMR) are two novel bio-markers associated with overall survival (OS) and prognosis in several types of cancers. The aim of this study is to investigate the value of HRR and LMR in newly diagnosed multiple myeloma (MM) patients.MethodsA total of 180 patients were included in this study. Patients diagnosed with MM between May 2013 and May 2019 at a single center were evaluated. HRR was calculated by dividing hemoglobin to RDW, both measured from the same sample. LMR was calculated by dividing absolute lymphocyte count (ALC) to absolute monocyte count (AMC).ResultsThe cutoff value for HRR was taken as 0.61, and the cutoff value for LMR was taken as 3.28. Patients were divided into low HRR, high HRR, low LMR, and high LMR groups. OS of the patients with low HRR was found lower compared with high HRR (36.7 months for low HRR and 53.2 months for high HRR, p &lt; 0.001). Also, OS was found lower in the low LMR group (39.4 months for low LMR and 51.7 months for high LMR, p = 0.016). On multivariate analysis, low HRR and low LMR were predictive factors of OS (hazard ratio (HR) 2.08, 95% confidence intervals (CI) 1.31–3.03, and p = 0.002 for low HRR; HR 1.47, 95% CI 0.92–2.29, and p = 0.010 for low LMR).ConclusionCombining both HRR and LMR could be a prognostic biomarker and it reflects the status of the immune system in newly diagnosed MM patients.

The Lymphocyte-to-monocyte Ratio Is an Independent Prognostic Indicator in Pancreatic Head Cancer that Correlates With Obstructive Jaundice.

Several indicators of systemic inflammation have been reported to predict the outcomes of patients with malignant tumors but have not been fully investigated. The aim of this study was to evaluate whether the preoperative lymphocyte-to-monocyte ratio (LMR) can predict the outcomes of patients with pancreatic head cancer. We studied 32 patients who underwent curative surgery for pancreatic head cancer in our hospital between 2006 and 2016. Patients were classified into high and low groups according to their LMR. The low LMR group had a significantly lower survival rate than the high LMR group (p=0.0313). A multivariate analysis showed that the pretreatment LMR (p=0.01) was an independent risk factor for cancer-related death. The LMR was correlated with obstructive jaundice (p=0.001). Preoperative LMR is a significant predictor of the outcome after pancreaticoduodenectomy in patients with pancreatic head cancer.

Abstract B34: The impact of lymphocyte-to-monocyte ratio (LMR) in patients with borderline resectable pancreatic head cancer after curative surgery

Abstract Introduction: The outcome of patients with borderline resectable pancreatic ductal adenocarcinoma (BR PDAC) remains dismal even if the patients received neoadjuvant chemotherapy followed by radical resection. Pancreatic resection is highly invasive and sometimes fatal; thus, useful preoperative indicators for favorable prognosis of patients with PDAC are needed. Lymphocyte-to-monocyte ratio (LMR) is a systemic inflammatory response marker associated with cancer outcome. In the present study, we evaluated the clinical significance of LMR for BR head-PDAC patients. Materials and Methods: Consecutive 67 borderline resectable (BR) head-PDAC patients who underwent pancreaticoduodenectomy from Jan. 2008 to Dec. 2017 at Chiba University Hospital were analyzed retrospectively. The levels of LMR were calculated by simply dividing the absolute lymphocyte count by the monocyte count from routine preoperative blood sample, and the cut-off value of LMR was determined by receiver operating curve analysis. All the participants were divided into two groups (High/Low) based on the level of LMR. Among the clinicopathologic factors, we analyzed the clinical significance of preoperative LMR using the Kaplan-Meier analysis and Cox proportional regression model. Results: The characteristics of participants were as follows: median age: 67 (interquartile range (IQR) 61-72) years old, sex M/F: 49/18, resectability based on NCCN 2018.2 (BR-PV/BR-A): 38/29, neoadjuvant chemotherapy (done/none): 36/31, adjuvant chemotherapy (done/none): 59/8, R0/1 resection: 51/16, respectively. The median level of preoperative LMR was 4.17 (IQR 2.51-6.09). The cut-off value of LMR was calculated to be 5.63 by applying Youden Index. All PDAC patients were classified into high LMR group (n=20) and low LMR group (n=47). The Kaplan-Meier analysis showed that the outcome of patients in high LMR group was significantly better compared to that in low LMR group (P=0.029 log-rank test). The median overall survival time after surgery was 17.6 months in low LMR group versus 38.1 months in high LMR group. Furthermore, multivariate analysis revealed that high LMR (P=0.012) and low preoperative CA19-9 level (P=0.012) were identified as independent prognostic factors of favorable outcomes in patients with BR head-PDAC. Conclusions: The present study demonstrated both LMR and preoperative CA19-9 were independent prognostic factors in patients with BR head-PDAC. Because these markers can be obtained preoperatively, they will contribute to determination of the strategy for treatment of BR PDAC patients. Citation Format: Yoji Miyahara, Shigetsugu Takano, Hideyuki Yoshitomi, Shingo Kagawa, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Daisuke Suzuki, Nozomu Sakai, Takashi Mishima, Eri Nakadai, Masayuki Ohtsuka. The impact of lymphocyte-to-monocyte ratio (LMR) in patients with borderline resectable pancreatic head cancer after curative surgery [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr B34.