Low Lymphocyte-to-monocyte Ratio Research Articles

The Immune Response of Cutaneous Basosquamous- and Squamous-Cell Carcinoma Associated with Sun Exposure

In recent years, there has been an observed increase in the frequency of cutaneous carcinoma, which correlates with sun exposure. This study aims to explore the variances of tumor characteristics and immune response markers among patients diagnosed with cutaneous squamous-cell carcinoma (SCC) and basosquamous-cell carcinoma (BSC) with varying levels of sun exposure. The objective is to elucidate the potential influence of sun exposure on tumor progression and immune response in these types of carcinomas. We conducted a retrospective observational study that included 132 patients diagnosed with SCC and BSC. Participants were separated into high- and low-sun exposure groups. Tumor characteristics and immune response markers, including lymphocyte percentage (LY%), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were assessed using the Mann–Whitney U test. Our findings revealed the interplay between sun exposure, inflammation, aging, and immune response. In 80% of cases, it was found that individuals had high sun exposure throughout their lifetime. Patients in the high sun exposure category had a significantly higher LY% than those with low sun exposure (24.22 ± 7.64 vs. 20.71 ± 8.10, p = 0.041). Also, the NLR was lower in patients with high sun exposure (3.08 ± 1.47 vs. 3.94 ± 2.43, p = 0.023). Regarding inflammatory markers, the erythrocyte sedimentation rate (ESR), LY%, NLR, and LMR showed significant differences between the two groups. Patients who were diagnosed with SCC had higher ESR values (p = 0.041), higher LY% (p = 0.037), higher NLR (p = 0.041), and lower LMR (p = 0.025). This study provides evidence supporting distinct tumor characteristics and immune response patterns in patients diagnosed with SCC and BSC with a high sun exposure history. These findings imply that sun exposure may contribute to tumor progression and influence the immune response in individuals with SCC and BSC.

The Relationship Between Composite Inflammatory Ratios and Complications of Massive Ischaemic Stroke.

To investigate the relationship between complications of massive cerebral infarction (MCI) and composite inflammatory ratios. A case-control study. Place and Duration of the Study: Department of Neurology, Affiliated Hospital of Putian University, Putian, China, from January 2019 to November 2021. Eighty-two patients with MCI underwent blood tests within 24 hours of admission. Complications such as cerebral herniation, haemorrhage transformation (HT), and stroke-associated pneumonia (SAP) were evaluated based on imaging examinations. The prognosis was assessed using the modified Rankin Scale score (mRS) at discharge. Among the 82 patients, the cerebral herniation group had higher levels of systemic immune inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) compared to the non-cerebral herniation group. MCI patients who developed HT had higher levels of SII, NLR, mean platelet volume/platelet (MPV/PLT), and platelet-to-lymphocyte ratio (PLR). The SAP group had higher levels of MPV/PLT and NLR compared to the non-SAP group. The poor prognosis group had higher SII and NLR levels but a lower lymphocyte-to-monocyte ratio (LMR) compared to the good prognosis group. NLR showed high accuracy in predicting complications and the short-term prognosis of MCI. SII was linked to cerebral herniation, HT, and the short-term prognosis of MCI. MPV/PLT was found to be related to SAP and HT caused by MCI. LMR may act as a protective factor for the short-term prognosis of MCI. Massive cerebral infarction, Neutrophil-to-lymphocyte ratio, Systemic immune inflammation index, Prognosis.

Effect of Intraoperative Opioid Dose on Perioperative Neutrophil-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio in Glioma.

The neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are inflammatory biomarkers. Until now, it is unknown the impact of opioid dosage on perioperative immunity in glioma patients. The aim of this study was to explore the effect of intraoperative opioid dosage on perioperative immune perturbations using NLR and LMR as inflammatory biomarkers and evaluate the correlation between inflammatory biomarkers and pathological grade of glioma. The study included 208 patients with primary glioma who underwent glioma resection from February 2012 to November 2019 at Harbin Medical University Cancer Hospital. Complete blood count (CBC) was collected at 3 time points: one week before surgery, and 24 hours and one week after surgery. Patients were divided into high-dose and low-dose groups, based on the median value of intraoperative opioid dose. The relationships between perioperative NLR, LMR and intraoperative opioid dosage were analyzed using repeated measurement analysis of variance (ANOVA). Correlations between preoperative various factors and pathological grade were analyzed by Spearman analysis. Receiver operating characteristic (ROC) curves were performed to assess the predictive performance of the NLR and LMR for pathological grade. The NLR (P=0.020) and lower LMR (P=0.037) were statistically significant different between high-dose and low-dose groups one week after surgery. The area under the curve (AUC) of the NLR to identify poor diagnosis was 0.685, which was superior to the LMR (AUC: 0.607) and indicated a correlation between the NLR with pathological grade. The preoperative NLR (P=0.000), LMR (P=0.009), age (P=0.000) and tumor size (P=0.001) exhibited a significant correlation with the pathological grade of glioma. Intraoperative opioids in the high-dose group were associated with higher NLR and lower LMR in postoperative glioma patients. The preoperative NLR and LMR demonstrated predictive value for distinguishing between high-grade and low-grade gliomas.

Prognostic model for relapsed/refractory transplant-ineligible diffuse large B-cell lymphoma utilizing the lymphocyte-to-monocyte ratio.

We conducted a multi-institutional retrospective study in 100 transplant-ineligible (TI) patients with diffuse large B-cell lymphoma (DLBCL) that relapsed or progressed after first-line R-CHOP (or -like) therapy to develop a robust predictive model for TI relapsed/refractory (r/r) DLBCL, which has a heterogeneous but poor prognosis by currently available treatment modalities other than chimeric antigen receptor T-cell (CAR-T) therapy or bispecific antibodies. The median age at relapse or progression was 76years. The median progression-free survival (PFS) and overall survival (OS) from the first progression were 11.5months and 21.9months, respectively. Multivariate analysis identified low lymphocyte-to-monocyte ratio (LMR), elevated high lactate dehydrogenase, and elevated C-reactive protein at progression as independent predictors of OS. A predictive model based on these three factors, here designated as the Kyoto Prognostic Index for r/r DLBCL (KPI-R), successfully stratified their OS and PFS with statistical significance. In addition, event-free survival less than 24months for R-CHOP and low LMR were identified as significant predictive factors for non-response in any sequence of salvage therapy. We concluded that LMR is a bonafide predictor of treatment response and prognosis in patients with TI r/r DLBCL, and may be helpful in treatment decision-making.

The role of preoperative hematological inflammatory markers as a predictor of meningioma grade: A systematic review and meta-analysis.

Inflammatory processes play an important role in the aggressiveness of a tumor. However, the relationship between inflammatory markers in meningioma grade is not well known. Knowledge of preoperative meningioma grade plays an important role in the prognosis and treatment of this tumor. This study aims to assess preoperative hematological inflammatory markers as a predictor of the pathological grade of meningioma. To ensure comprehensive retrieval of relevant studies, we searched the following key databases, PubMed, Science Direct, and Biomed Central, with evidence related to preoperative hematological inflammatory markers among meningioma up to September 2023. The studies involved were selected based on established eligibility criteria. The analysis in this study uses Review Manager 5.4. Six studies were obtained from the search results. The total number of patients 2789 (469 high-grade meningioma and 2320 low-grade meningioma) analysis shows elevated neutrophil-to-lymphocyte ratio (NLR) (mean difference [MD]: 0.29; 95% confidence interval [CI] 0.13-0.45; P = 0.0004), monocyte-to-lymphocyte ratio (MLR) (MD: 0.02; 95% CI 0.00-0.04; P = 0.003), and low lymphocyte-to-monocyte ratio (LMR) (MD: -0.82; 95% CI -1.46--0.18; P = 0.005) significantly associated with high-grade meningioma compared to low-grade meningioma. No significant correlation between high-grade and low-grade meningioma based on platelet-lymphocyte ratio value is observed. The parameters of NLR, MLR, and LMR have been found to be cost-effective preoperative methods that demonstrate potential value in the prediction of meningioma grade. To enhance the reliability of the findings, it is imperative to do further prospective study.

Prognostic Value of Lymphocyte-to-Monocyte Ratio (LMR) in Patients With Prostate Cancer: A Systematic Review and Meta-Analysis.

The objective of this study is to evaluate the prognostic value of lymphocyte-to-monocyte ratio (LMR) in patients with prostate cancer (PCa) by a method of meta-analysis. China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, Web of Science, Cochrane Library, and Embase were searched to collect relevant literature until March 2023. The Newcastle-Ottawa Scale was used to assess the bias risk of the literature included. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate the prognostic value of LMR in PCa. Stata 15.0 statistical software was used for data analysis. A total of six published articles were included in this meta-analysis, containing 1,104 patients with PCa. The results of the meta-analysis indicated better overall survival (OS; HR = 1.73, 95% CI: 1.73, p = .001) and progression-free survival (PFS; HR = 2.63, 95% CI: 1.58~4.38, p < .001) in patients with PCa with low LMR compared with high LMR. In conclusion, compared with low LMR, PCa patients with high LMR have a better prognosis. LMR is an independent risk factor affecting the long-term prognosis of patients with PCa. The detection of LMR before treatment is of certain significance in judging the clinical prognosis of patients with PCa.

An inflammation-based model for identifying severe acute pancreatitis: a single-center retrospective study

Background and aimsSevere acute pancreatitis (SAP) is potentially lethal. Considering the role of inflammation in the progression of acute pancreatitis (AP), this study aims to develop a model based on inflammatory indexes for identifying the presence of SAP.MethodsOverall, 253 patients with AP who were consecutively admitted between July 2018 and November 2020 were screened, of whom 60 had SAP. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-platelet ratio (NPR), systemic inflammation response index (SIRI), platelet-to-albumin ratio (PAR), C-reactive protein-to-albumin ratio (CAR), C-reactive protein-to-lymphocyte ratio (CLR), and triglyceride glucose (TyG) index were calculated. Multivariate logistic regression analyses were performed to identify independent risk factors of SAP. Then, inflammation-based models were established. Receiver operating characteristics (ROC) curve analyses were performed. Area under ROC curve (AUROC) was calculated.ResultsDiabetes mellitus, fatty liver, high white blood cell count (WBC), C-reactive protein (CRP), red blood cell distribution width (RDW), procalcitonin (PCT), SII, NLR, NPR, CAR, CLR, and TyG index, and a low LMR were significantly associated with SAP. Considering the collinearity among these variables, 10 multivariate logistic regression analyses were separately performed. Finally, four independent inflammation-based models were established. Of them, the best one, which was calculated as follows: 1.204*fatty liver (yes = 1; no = 0) + 0.419*PCT + 0.005*CLR - 2.629, had an AUROC of 0.795 with a specificity of 73.4% and a sensitivity of 71.7%.ConclusionThe inflammation-based model consisting of fatty liver, PCT, and CLR has a good diagnostic performance for SAP.

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.

Clinicohematological Details of Alcoholics Affected with Dengue: A Retrospective Observation

Abstract Introduction: Dengue is a tropical disease, and alcohol abuse is also common in developing countries in the tropics. Patients with alcoholism and dengue may have more complications due to compromised liver functions. Hence, the changes in hematological and biochemical parameters among alcoholic dengue patients need to be analyzed for warning changes to improve treatment outcomes. The present study was conducted to compare the hematological and biochemical profiles of dengue patients with and without alcoholism. Materials and Methods: This was a retrospective study conducted with data from healthy individuals and dengue patients with and without alcoholism. The demographic details, signs and symptoms, and hematological and biochemical (hepatorenal) parameters were studied. The neutrophil-to-lymphocyte ratio, lymphocyte-to-neutrophil ratio, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index were studied. Results: A total of 252 patients were diagnosed with dengue during the study; 33 (13.09) had known cases of alcohol abuse, and almost equal numbers of age- and sex-matched healthy individuals, i.e., 251, were included in the study. Symptoms such as reduced urine output, melena, skin rashes, retro-orbital pain, and hematuria were observed more often in alcoholic patients than in nonalcoholic dengue patients. The total leukocyte count, MLR, total bilirubin, urea level, and creatinine level were greater, and the platelet (PLT) count and lymphocyte-to-monocyte ratio (LMR) were lower in alcoholic dengue patients than in nonalcoholic dengue patients. Conclusion: Compared with those in nonalcoholic dengue patients, the signs and symptoms in alcoholic dengue patients appear to be more aggressive, especially for malena and hematuria. A low PLT, LMR, and elevated total bilirubin, urea, and creatinine in alcoholic dengue patients are considered to be crucial for determining treatment outcomes.

Lymphocyte to Monocyte Ratio Is an Independent Prognostic Factor in Patients With Esophageal Cancer Who Receive Curative Treatment.

This study evaluated the clinical impact of the lymphocyte-to-monocyte ratio (LMR) in patients with esophageal cancer who received curative treatment and perioperative adjuvant treatment. The association between LMR and the clinicopathological characteristics of patients with esophageal cancer was also investigated. This study included 181 patients who underwent curative treatment for esophageal cancer between 2005 and 2020. The prognosis and clinicopathological parameters of patients with high and low LMR statuses were analyzed. The OS rates at 3 and 5 years after surgery were significantly lower (40.6% and 33.8%, respectively) in the low-LMR group than in the high-LMR group (67.1% and 58.4%, respectively). The pretreatment LMR was selected as an independent prognostic factor in the multivariate analysis model [hazard ratio (HR)=2.606; 95%CI=1.504-4.516, p<0.001]. Similar results were observed for RFS. Furthermore, LMR was associated with the occurrence of postoperative surgical complications and hematological recurrence. The incidence of anastomotic leakage was 63.3% in the low-LMR group and 27.2% in the high-LMR group (p<0.001). Moreover, the hematologic recurrence rate in the low-LMR group was significantly higher than that in the high-LMR group (46.7% vs. 23.8%, p=0.011). The LMR may be a promising prognostic and predictive factor for esophageal cancer, and may be used to select optimal treatment strategies in the future.

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.

Prognostic significance of HALP score and combination of peripheral blood multiple indicators in patients with early breast cancer.

To assess the prognostic significance of preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score combined with multiple peripheral blood indicators in patients with early breast cancer (EBC). A total of 411 patients with early invasive breast cancer underwent breast-conserving surgery or radical surgery at Changzhou No.2 People's Hospital from January 2015 to December 2020. The cut-off values of HALP, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) were calculated using the software X-tile. The primary outcomes were recurrence-free survival (RFS), which was analyzed using the Kaplan Meier (K-M) method, while log-rank was used to test the differences between high and low curves. Cox regression analysis was used to analyze the prognostic significance of HALP. Furthermore, the prognostic predictive value of independent prognostic factors was determined using the receiver operating characteristic (ROC) curve. Low HALP score (P<0.0001), high PLR (P<0.0001), and low LMR (P = 0.0345) were significantly associated with worse RFS. Body mass index (BMI)<24 (P = 0.0036), no diabetes (P = 0.0205), earlier TNM stage (P = 0.0005), and no lymph node metastasis (P = 0.0022) were positively correlated with longer survival HALP scores (hazard ratio [HR] 95% confidence interval [CI]: 0.08 (0.024-0.265), P<0.0001), BMI (HR 95%CI: 0.254 (0.109-0.589), P = 0.001), TNM stage (HR 95%CI: 0.153 (0.041-0.571), P = 0.005), and diabetes (HR 95%CI: 0.259 (0.085-0.785), P = 0.017) were demonstrated as independent prognostic factors by Cox regression analysis. The ROC curves depicted that the two most valuable factors were TNM stage and HALP, and combined independent factors were more accurate in prognostic prediction than any single factor. This further indicated that the TNM stage combined HALP or BMI were more valuable combinations. The HALP score was an independent prognostic factor for EBC and was significantly associated with worse RFS. This score may predict the probability of postoperative tumor recurrence or metastasis before surgery.

Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with glioma: a meta-analysis

BackgroundMany studies have explored the prognostic role of the lymphocyte-to-monocyte ratio (LMR) in patients with glioma, but the results have been inconsistent. We therefore conducted the current meta-analysis to identify the accurate prognostic effect of LMR in glioma.MethodsThe electronic databases of PubMed, Web of Science, Embase, and Cochrane Library were thoroughly searched from inception to July 25, 2023. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to estimate the prognostic role of LMR for glioma.ResultsA total of 16 studies comprising 3,407 patients were included in this meta-analysis. A low LMR was significantly associated with worse overall survival (OS) (HR = 1.35, 95% CI = 1.13–1.61, p = 0.001) in glioma. However, there was no significant correlation between LMR and progression-free survival (PFS) (HR = 1.20, 95% CI = 0.75–1.91, p = 0.442) in glioma patients. Subgroup analysis indicated that a low LMR was significantly associated with inferior OS and PFS in glioma when using a cutoff value of ≤ 3.7 or when patients received mixed treatment.ConclusionsThis meta-analysis demonstrated that a low LMR was significantly associated with poor OS in glioma. There was no significant correlation between LMR and PFS in glioma patients. The LMR could be a promising and cost-effective prognostic biomarker in patients with glioma in clinical practice.

Platelet-to-lymphocyte, neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios are related to cancer-related fatigue and quality of life in patients with cancer: a cross-sectional study

ObjectivesTo explore the association of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) with cancer-related fatigue (CRF) and quality of life (QOL) in cancer patients.DesignA cross-sectional study.SettingsA...

Ratio of Circulating CD8 + T Lymphocytes to M-MDSCs (CD8MMR): A Novel Prognostic Predictor for Treatment-Naïve DLBCL Patients

Introduction: CD8 + T lymphocytes are crucial in contemporary cell-and-immunotherapies as they can be functionally enhanced or manipulated. Monocytic myeloid-derived suppressor cells (M-MDSCs) are known for their intense immunosuppressive ability, and higher percentages of circulating M-MDSCs among peripheral-blood monocytes or white cells are associated with a worse prognosis. Recently, a low lymphocyte-to-monocyte ratio (LMR) has been linked to a poor prognosis in lymphoma patients. Consequently, we hypothesized that the ratio of circulating CD8 + T lymphocytes to M-MDSCs (CD8MMR) could be a novel and more precise predictor for the clinical outcomes of DLBCL patients before initiating treatment. Methods: This prospective, observational study enrolled 136 adults with treatment-naïve DLBCL from May 2019 to March 2023 in a tertiary medical center in Taiwan. Patients with primary CNS lymphoma or primary mediastinal B-cell lymphoma were excluded. Fresh peripheral blood samples were obtained to calculate the absolute counts of CD8 + T lymphocytes and M-MDSCs, defined as alive singlets with CD45 + CD3 + CD8 + and CD45 + CD15 - CD14 + CD11b + CD33 + HLA-DR low/- by flow cytometry, respectively. ROC analysis and AUC determined the cut-off values for LMR and CD8MMR. Results: For 136 treatment-naïve DLBCL patients, the median age was 70, with 61.8% being male. Among them, 37.5% were in stage IV, and 27.9% were classified as the germinal-center B-cell (GCB) subtype by IHC staining according to the Hans algorithm. Additionally, 43.4% were diagnosed with double expressor lymphoma (DEL). The IPI risk score distribution was as follows: 7.4%, 18.4%, 17.6%, 24.3%, 19.9%, and 12.5% were in scores 0, 1, 2, 3, 4, and 5, respectively. Of note, the median level of LMR was 2.17, the median level of absolute counts of circulating CD8 + T lymphocytes was 385/µL, the median level of absolute counts of circulating M-MDSCs was 102/µL, and the median level of CD8MMR was 3.56. DLBCL patients with high-risk IPI had a significantly lower CD8MMR than patients with intermediate or low-risk IPI (1.34 vs. 4.51 vs. 7.82, PH vs. L = 0.001, PH vs. I = 0.060, PI vs. L = 0.082). DLBCL patients with the non-GCB subtype (2.75 vs. 5.63, P = 0.031) also demonstrated a significantly lower CD8MMR. Additionally, there were trends of lower CD8MMR in elderly patients &amp;gt; 70 (2.74 vs. 3.91, P = 0.209) and patients with DEL (3.33 vs. 4.65, P = 0.101). After a median follow-up of 22.6 months for the 136 DLBCL patients, LMR was at first tested, and patients with LMR &amp;lt; 1.19 had significantly worse PFS (13.8 months vs. non-reach, Log Rank P = 0.004) and OS (non-reach vs. non-reach, Log Rank P = 0.019) than those with LMR ≥ 1.19. Next, we examined the CD8MMR, and patients with CD8MMR &amp;lt; 4.40 experienced significantly worse PFS (21.3 months vs. non-reach, Log Rank P &amp;lt; 0.001) and OS (non-reach vs. non-reach, Log Rank P &amp;lt; 0.001) compared to those with CD8MMR ≥ 4.40 [Figure]. We subsequently conducted a multivariate Cox regression analysis to validate whether CD8MMR &amp;lt; 4.40 could serve as an independent predictor of poor prognosis [Table]. The results showed that “CD8MMR &amp;lt; 4.40” was confirmed as an independent prognostic factor for both PFS (HR = 2.747; 95% CI = 1.275 to 5.918; P = 0.010) and OS (HR = 3.669; 95% CI = 1.462 to 9.211; P = 0.006) after adjusting for confounding factors, including age, sex, IPI risk scores, bulky mass &amp;gt; 10 cm, non-GCB type, DEL, and LMR &amp;lt; 1.19. In this study cohort, 106 (77.9%) patients received R-CHOP-like regimens as induction therapies, 25 (18.4%) patients received an R-EPOCH regimen, two (1.5%) patients received an R-HyperCVAD regimen, and three (2.2%) patients died before completing the first cycle of chemoimmunotherapy. Among the 106 DLBCL patients receiving R-CHOP-like regimens, 57 patients showed CD8MMR &amp;lt; 4.40 and reported a significantly lower rate of complete remission (73.7% vs. 95.9%, P = 0.006) at the end of induction therapy compared to the 49 patients with CD8MMR ≥ 4.40. Furthermore, patients with CD8MMR &amp;lt; 4.40 had significantly worse PFS (17.4 months vs. non-reach, P &amp;lt; 0.001) and OS (non-reach vs. non-reach, P &amp;lt; 0.001) compared to those with CD8MMR ≥ 4.40. Conclusion: A low ratio of circulating CD8 + T lymphocytes to M-MDSCs (CD8MMR) serves as a poor prognostic factor for both PFS and OS in treatment-naïve DLBCL patients. This finding warrants further investigation and highlights the possibility of risk-adapted strategies when treating DLBCL patients.

Significance of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in the Prognosis of Newly Diagnosed Multiple Myeloma Patients

Background Multiple myeloma is a cancer of the plasma cells, characterized by abnormal proliferation in the bone marrow. In 2023 about 12,590 deaths are expected to occur secondary to the disease. It is important to identify the predictors of disease progression for prognostication.Tumor microenvironment influences the growth of malignant plasma cells. Neutrophilia can enhance tumor growth, angiogenesis and provide a favorable matrix for metastasis. Lymphopenia is also suggestive of disease progression. Hence, an increased neutrophil-to-lymphocyte ratio (NLR) has been linked with a poor prognosis in many cancers. Monocytes are thought to be recruited by tumor cells for suppressing the immune cells and aiding in prolonged survival. In patients with multiple myeloma, a low platelet count is linked to a worse prognosis since a greater marrow myeloma burden leads to inhibition of thrombopoiesis.Hence, a low platelet-to-lymphocyte ratio (PLR) and high monocyte-to-lymphocyte ratio (MLR) are linked with worse prognosis.The aim of our study was to investigate the role of NLR, PLR and MLR in the prognosis of our patients. Methods This is a retrospective study that analyzed patients diagnosed with Multiple Myeloma from 2012 to 2022 at Saint Vincent Cancer Center, Worcester, Massachusetts. We performed a chart review and collected demographics including age at the time of diagnosis, gender, BMI, race. Additionally, we also collected data such as multiple myeloma type, R-ISS staging, complete blood count (cbc), chemotherapy used, auto stem cell transplant, 5-year survival. NLR, PLR and MLR were calculated based on pre-treatment cbc. Based on literature review, cutoffs for High NLR (≥2), Low NLR (&amp;lt;2), High PLR (≥120.00), low PLR (&amp;lt;120.00) and high MLR (≥0.27), and low MLR (&amp;lt;0.27) were made. SPSS was used for analysis of the data. A logistic regression was used to calculate the Odd's ratio (OR). A p value less than equal to 0.05 was considered significant. Results The total number of patients analyzed were 97. 47.4% (n=46) were females and 52.6% (n=51) were males. Mean age at diagnosis was 69.3 years. Mean BMI was 30.16 kg/m 2. 35.1% (n=34) of the patients had IgG subtype. 36.1% (n=35) of our study population belonged to R-ISS stage 2. 38.1% (n=37) of the patients were treated with lenalidomide, bortezomib, dexamethasone combination. Mean NLR was 3.4, mean PLR was 166.949 and mean MLR was 0.46. 66% (n=64) of the patients belonged to the high NLR group, 61.9% (n=60) to the high PLR group and 64.9% (n=63) to the high MLR group. Out of 97 patients, 56.7% (n=55) were alive at 5 years. High NLR (≥2) was associated with lower odds of 5-year survival with a p value of 0.037 and a 95% confidence interval (0.095-0.931). High MLR (≥0.27) was associated with lower odds of 5-year survival with a p value of 0.042 and a 95% confidence interval (0.124-0.962). PLR did not correlate with 5-year survival and was not statistically significant (p value of 0.157). Conclusions Based on our study, a high NLR (≥2) and high MLR (≥0.27) were associated with lower odds of 5-year survival. Hence NLR and MLR are independent prognostic factors in newly diagnosed multiple myeloma patients which can be economical and effective methods for early evaluation of patient prognosis.

Monocyte-to-lymphocyte ratio as predictor of cancer therapy-related cardiotoxicity in patients with breast cancer

Abstract Background Elevated pre-treatment baseline inflammation has been associated with cancer therapy-related cardiac dysfunction (CTRCD) in patients with breast cancer. Monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index [SII = (neutrophil × platelets)/ lymphocyte] are inflammation markers easily obtained through of the blood count. Purpose To evaluate the development of CTRCD according to pre-treatment blood inflammatory biomarkers in patients with breast cancer. To evaluate the development of CTRCD in patients with HER2+ early breast cancer according to MLR, NLR, PLR, and SII inflammatory markers obtained from pre-cancer therapy blood count. Methods Prospective cohort study including consecutive female patients ≥ 18 years with HER2+ early breast cancer who consulted at the institution's breast oncology outpatient clinic between march/2019 and march/2022. This study was approved by the Institutional Review Board (protocol No. 2019-0010). Furthermore, it was conducted in accordance with Resolution no.466/12 of the National Health Council. CTRCD: absolute reduction in LVEF &amp;gt; 10% to below 53% (2D-echocardiogram). Survival analysis was performed using Kaplan-Meier curves, compared by the log-rank test, and discrimination ability was evaluated through area under the ROC curve (AUC-ROC). P &amp;lt; 0.05 was considered statistically significant. Results Forty-nine patients (53.3±13.3y) were included and followed up for a median of 13.2 (IQR 25-75%: 10.8-16.1) months. CTRCD was observed in 6 (12.2%) patients. Patients with high blood inflammatory biomarkers had lower CTRCD-free survival (P &amp;lt; 0.050 for all, Figure A-D). MLR showed statistically significant AUC-ROC (0.802; P = 0.017). CTRCD was observed in 27.8% of patients with high MLR vs. 3.2% with low MLR (P = 0.020); negative predictive value was 96.8% (95%CI: 83.3-99.4%). Conclusions In patients with breast cancer, elevated pre-treatment inflammatory markers were associated with increased risk of cardiotoxicity. Among these markers, MLR had good discriminatory performance and high negative predictive value. The incorporation of MLR might improve risk evaluation and selection of patients for follow-up during cancer therapy.Figure (A-D)

A novel prognostic prediction indicator in patients with acute pulmonary embolism: Naples prognostic score

Acute pulmonary embolism (APE) is a potentially fatal disease. Early risk stratification is essential to determining appropriate treatment. We aimed to investigate the predictive value of the Naples Prognostic Score (NPS) for 30-day all-cause mortality in patients with APE. In this retrospective analysis, 325 hospitalized patients with APE were divided into Groups 0 (n = 131), 1 (n = 153), and 2 (n = 41) according to the NPS. The primary outcome event was all-cause mortality during 30 days of follow-up from the day of admission. The correlation between NPS, clinical features, and outcomes in each group was evaluated. The patients were divided into two groups, survivor (n = 294) and nonsurvivor (n = 31), according to their prognosis. The results of the comparison between the three NPS groups revealed that patients with older age, faster heart rate, lower systolic blood pressure, low albumin and total cholesterol levels, high neutrophil to lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR), right heart dilatation, heart failure, malignancy, and lower extremity venous thrombosis had significantly higher 30-day all-cause mortality (P < 0.05). Area under the receiver operating characteristic curve (AUC) for NPS to predict all-cause death within 30 days in patients with APE was 0.780 (95% confidence interval [CI] = 0.678–0.855), with sensitivity being 80.6% (95% CI = 0.667–0.946) and specificity being 72.1% (95% CI = 0.670–0.772). Kaplan-Meier (KM) curves showed that Group 2 APE patients had the highest risk of all-cause mortality compared with the other two groups (log-rank test, P = 0.0004). Forest plot visualization using the Cox proportional hazard model showed a significant increase in the risk of 30-day all-cause mortality by 239% (hazard ratio [HR] = 3.385 [1.115–10.273], P = 0.031) and 338% (HR = 4.377 [1.228–15.598], P = 0.023), and the trend test showed a statistical difference (P = 0.042). The study concluded that NPS is a novel, reliable, and multidimensional prognostic scoring system with good prediction of 30-day all-cause mortality in patients with APE.

Relation Between Monocyte-to-lymphocyte Ratio and Depressive Symptoms in Patients with Non-severe Covid-19 Infection

Background and Aim: Mental health of non-hospitalized patients and those with non-severe infections has attracted lower attention in comparison to other patients. Circulating monocytes are deeply involved in all stages of COVID-19 infection. The present study aimed to investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and depressive symptoms in patients with non-severe COVID-19 infection. Patients and Methods: The study included 312 patients with non-severe COVID-19 infection diagnosed on the basis of a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal swabs. Depressive symptoms were assessed using the validated Arabic version of the 7-item Hamilton Depression Rating Scale (HAMD). According to the obtained scores, patients were classified to have mild (10-13), moderate (14- 17), or severe depression (&gt;17). Results: The present study included 312 patients with non-severe COVID-19. According to HAMDS, clinically significant depression was diagnosed in 144 patients (46.2 %). They comprised 38 patients (12.2 %) with mild depression, 30 patients (9.6 %) with mild-tomoderate depression and 76 patients (24.4 %) with moderate-to-severe depression. Multivariate logistic regression analysis identified male sex [OR (95% CI): 2.07 (1.27-3.36), p = 0.003], presence of dyspnea [(OR (95 % CI): 1.99 (1.21-3.27), p = 0.007], D dimer levels [OR (95% CI): 2.32 (1.19-4.52), p = 0.013], MLR [OR (95% CI): 0.52 (0.28-0.99), p = 0.046] and abnormal CT findings [OR (95% CI): 1.79 (1.08-2.95), p = 0.023] as significant predictors of depression in the studied patients. Conclusion: Low MLR is related to depressive symptoms in patients with non-severe covid-19 infection. Other predictors include male sex, dyspnea, abnormal CT findings and elevated D-dimer levels.