Preoperative Lymphocyte-monocyte Ratio Research Articles

Association between admission inflammatory indicators and 3-year mortality risk in geriatric patients after hip fracture surgery: a retrospective cohort study.

Recent research indicates that the monocyte lymphocyte ratio (MLR), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP), and systemic immune-inflammation index (SII) may serve as valuable predictors of early postoperative mortality in elderly individuals with hip fractures. The primary objective of the study was to examine the association between preoperative MLR, NLR, PLR, CRP, and SII levels and 3-year mortality risk in geriatric patients after hip fracture surgery. The study included patients aged 65 years or older who underwent hip fracture surgery between November 2018 and November 2019. Admission levels of MLR, NLR, PLR, CRP, and SII were measured. The median follow-up period was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR) for mortality with adjusting for potential covariates. Time-dependent receiver operating characteristic (ROC) curves were employed to assess the predictive capability of inflammatory indicators for mortality. A total of 760 patients completed the follow-up (79.4 ± 7.8 years, 71.1% female). A higher preoperative MLR was found to be significantly associated with an increased 3-year postoperative mortality risk (HR 1.811, 95% CI 1.047-3.132, P = 0.034). However, no significant correlations were observed between preoperative NLR, PLR, CRP, SII and 3-year mortality. The areas under the ROC curve (AUCs) of MLR for predicting 30-day, 120-day, 1-year, and 3-year mortality were 0.74 (95% CI 0.53-0.95), 0.70 (95% CI 0.57-0.83), 0.67 (95% CI 0.60-0.74), and 0.61 (95% CI 0.56-0.66), respectively. Preoperative MLR is a useful inflammatory marker for predicting 3-year mortality in elderly hip fracture patients, but its predictive ability diminishes over time.

The Prognostic Value of the Combination of the Prognostic Nutritional Index and the Lymphocyte:Monocyte Ratio for the Prediction of Patients with Muscle-Invasive Bladder Cancer.

To explore the efficacy of combining the prognostic nutritional index (PNI) and the lymphocyte:monocyte ratio (LMR) for patients with muscle-invasive bladder cancer (MIBC). Of 172 patients who were diagnosed with MIBC in our hospital, 94 were eligible for the study. The clinical data of the 94 patients with MIBC were collected. The patients were divided according to the optimal cut-off values for the preoperative PNI and LMR into a low-PNI subgroup (PNI <44.15, 52 patients), a high-PNI subgroup (PNI ≥44.15, 42 patients), a low-LMR subgroup (LMR <2.98, 50 patients) and a high-LMR subgroup (LMR ≥2.98, 44 patients). The area under the receiver operating characteristic (ROC) curve (AUC) was used to analyse the efficacy of the PNI and the LMR in predicting the prognosis of patients with MIBC. Univariate and multivariate logistic regression analyses were performed to evaluate prognostic factors for patients with MIBC. Kaplan-Meier (K‒M) survival analysis was used for overall survival (OS) analysis to explore the ability of the PNI combined with the LMR to predict the prognosis of patients with MIBC. The optimal cut-off values for the preoperative PNI and the preoperative LMR were 44.15 and 2.98, respectively, on the basis of ROC curves. ROC curve analysis revealed that the PNI (AUC = 0.720, sensitivity 65.9%, specificity 74.50%, Youden index 0.399) and the LMR (AUC = 0.724, sensitivity 65.9%, specificity 70.0%, Youden index 0.395) both had good prognostic efficacy for patients with MIBC. The results of univariate and multivariate logistic regression analyses showed that preoperative PNI <44.15 was an independent risk factor for OS in patients with MIBC (p = 0.027). Based on K‒M survival curve analysis, patients with PNI <44.15 and LMR <2.98 had the shortest OS (p = 0.00002). Low preoperative PNI and LMR values are indicative of poor prognosis in patients with MIBC. The efficacy of their combination was better than that of the factors independently.

Impact of Lymphocyte/Monocyte Ratio on Outcomes in Patients with Remnant Gastric Cancer After Gastrectomy.

The inflammatory response plays a crucial role in tumor development. Inflammatory markers are recognized prognostic factors in many types of cancer, including gastric cancer. However, the correlation between inflammatory markers and prognosis in remnant gastric cancer (RGC) remains unclear. The aim of this study was to evaluate the importance of inflammatory markers as a prognostic factor in patients who underwent gastrectomy for RGC. This multicenter retrospective study involved 107 patients with RGC who underwent curative gastrectomy at 10 institutions in Japan between January 2000 and December 2016. Both overall survival (OS) and relapse-free survival (RFS) were analyzed. Receiver operating characteristic analyses indicated that the lymphocyte/monocyte ratio (LMR) had a higher area under the curve compared with other potential prognostic factors. Patients were categorized into high- and low LMR groups by the optimal LMR cutoff value. Preoperative LMR was significantly correlated with reconstruction way after the primary surgery (p=0.032) and lymphatic invasion (p=0.046). OS and RFS were significantly worse in the low- vs high LMR groups. Low LMR, T3 or deeper tumor invasion, and low body mass index were independent prognostic factors for OS and RFS. Preoperative low LMR is associated with poor OS and RFS in patients who undergo gastrectomy for RGC.

Association of preoperative monocyte/lymphocyte ratio with postoperative oxygenation impairment in patients with acute aortic syndrome

Postoperative oxygenation impairment represents a common complication in patients with the acute aortic syndrome (AAS). The study aimed to explore the relationship between inflammatory indicators and AAS patients with oxygenation impairment after operation. In this study, 330 AAS patients who underwent surgery were enrolled and divided into 2 groups based on postoperative oxygenation impairment (non-oxygenation impairment group and oxygenation impairment group). Regression analysis was performed to assess the relationship between inflammatory indicators and postoperative oxygenation impairment. A smooth curve and interaction analysis were further conducted. Stratified analysis was used according to preoperative monocyte/lymphocyte ratio (MLR) (Tertiles). Multivariate analysis showed that preoperative MLR was independently related to oxygenation impairment after surgery in AAS patients (OR, 95% CI, P: 2.77, 1.10-7.00, 0.031). The smooth curve indicated the risk of postoperative oxygenation impairment was higher with the elevated preoperative MLR. Interaction analysis revealed that patients with AAS with high preoperative MLR who had coronary artery disease (CAD) had a higher risk of oxygenation impairment after operation. Moreover, stratified analysis was performed according to baseline MLR (Tertiles), and a higher baseline MLR level in AAS patients was correlated with a lower arterial oxygen tension (PaO2) / inspiratory oxygen fraction (FiO2) ratio perioperatively. In AAS patients, preoperative MLR level was independently related to postoperative oxygenation impairment.

Association between preoperative hematologic markers and aggressive behavior in meningiomas

IntroductionMeningiomas have varying degrees of aggressive behavior. Some systemic hematologic makers are associated with malignancy, but their value in predicting aggressive meningioma behavior is not fully understood. ObjectiveTo evaluate the association between preoperative markers such as neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), and diagnostic and prognostic factors including WHO grade, proliferation index, presence of edema on preoperative MRI, and tumor recurrence. MethodsA retrospective review of patients treated between 2000 and 2019 with a preoperative complete blood count (CBC) differential lab draw before intracranial meningioma resection was conducted. All preoperative steroid dosages were converted to dexamethasone equivalents. Primary outcomes included presence/absence of perilesional edema, WHO grade, Ki-67/MIB-index, and recurrence. Univariate and multivariable regression analyses were conducted. ResultsA total of 209 meningioma patients were included. Of these, 143 (68 %) were WHO grade I, 61 (29 %) grade II and 5 (2 %) were grade III. Recurrence was reported in 19 (9.1 %) tumors. No hematologic markers were associated with recurrence. In separate multivariable logistic analyses, no biomarkers were associated with perilesional edema or WHO grade. MLR was associated with higher MIB-index (p = 0.018, OR 6.57, 95 % CI 1.37–30.91). ConclusionMost hematologic markers were not associated with meningioma invasiveness, grade, proliferative index, or aggressiveness. Preoperative MLR was associated with high proliferation index in patients undergoing surgery for intracranial meningioma. Higher MLR could be a surrogate for meningioma proliferation and has potential to be used as an adjunct for risk-stratifying meningiomas.

Comparative Analysis of Preoperative Ratio Based Markers in Predicting Postoperative Infectious Complications After Gastrectomy

Postoperative infections (POIs) are associated with prolonged postoperative recovery, delayed adjuvant therapy, psychological problems, and poor long-term outcomes. The study aims to cross-compare the ratio-based preoperative parameters to predict POIs in patients with D2 gastrectomy for gastric cancer. A retrospective cohort and single-center study evaluated the data of 293 patients who underwent curative gastrectomy between January 2007 and November 2019 in a tertiary hospital in Istanbul. A receiver operating characteristic (ROC) curve was used to assess the ability of laboratory values to predict clinically relevant POIs. The predictive capacity of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR) was calculated by the area under the curve. Then, the cutoff points were determined for all 4 indexes. POIs developed in 77 (26.2%) patients. Patients with POI had higher Charlson comorbidity index (CCI) scores and a longer length of hospital stay. ROC curve analysis revealed that NLR, LMR, and CAR were significantly effective in predicting POI, while PLR was ineffective. LMR was the best ability to predict the POI. According to multivariate analysis, CCI score 3, NLR&gt; 3.8, and LMR 2.34 were independent risk factors influencing the POI. Preoperative LMR was most predictive for POI. Although CAR predicted the development of the POI, it was not superior to LMR and NLR. PLR did not have any prediction for POI. In addition, increased comorbidity (CCI 3) was an independent risk factor for POI.

Preoperative high lymphocyte-to-monocyte ratio is associated with intraoperative type I endoleak in patients with TAA with TEVAR.

Various inflammatory factors are closely associated with the incidence of thoracic aortic aneurysms (TAAs). Furthermore, the severity of inflammation is closely related to the absolute value and proportion of each leukocyte subgroup. Only few reports have analyzed the importance of lymphocyte-monocyte ratio (LMR) as a potential inflammatory marker in vascular diseases. Therefore, we aimed to investigate the effect of peripheral blood LMR on thoracic endovascular aortic repair (TEVAR) in patients with TAA. A retrospective study of the clinical data collected in our hospital between January 2016 and January 2021 was performed on 162 patients with TAA treated with TEVAR, based on the inclusion and exclusion criteria for patient selection. Based on whether the patient had the clinical symptoms at admission and the occurrence of type I endoleaks during operation, patients were divided into two groups, respectively: an intraoperative type I endoleak group (n = 34) and a group without intraoperative type I endoleak (n = 128), and a group with clinical symptoms (n = 31) and a group without clinical symptoms (n = 131). The clinical data of these two groups were compared, the free from second intervention rates related to endoleak and the preoperatively LMR of the two groups was calculated. LMR was calculated preoperatively. Receiver-operating characteristic curve analysis was used to determine the cut-off for preoperative LMR values. Based on the cut-off point, patients were divided into a high LMR group (n = 34) and a low LMR group (n = 128). The clinical data of the two groups were compared, and further stratified analysis was performed. A total of 162 patients were included in the analysis. All patients were successfully implanted with a thoracic aorta stent graft. The preoperative LMR level and postoperative endoleak-related secondary intervention rate were higher in the type I endoleak group than those in the group without intraoperative type I endoleaks. The preoperative C-reactive protein (CRP) level of patients with TAA with clinical symptoms was higher than that of asymptomatic patients. There was a negative correlation between preoperative CRP and LMR levels. In addition, in symptomatic or asymptomatic patients, the LMR level was associated with the occurrence of intraoperative type I endoleaks. After excluding the influence of type of endografts, our results showed that the clinical symptoms did not affect the occurrence of the intraoperative type I endoleak, and patients with intraoperative type I endoleak had a higher rate of postoperative secondary intervention. Patients with TAA with type I endoleaks during TEVAR had an increased rate of secondary intervention related to endoleaks. Patients with TAA with high LMR levels before TEVAR were more likely to have endoleaks during operation.

Correlation between preoperative inflammatory biomarkers and postoperative pneumonia or long-term prognosis in patients with esophageal cancer after neoadjuvant therapy

Objective: To examine the correlation between neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and neutrophil-monocyte ratio (NMR) for postoperative pneumonia or long-term overall survival in patients with esophageal cancer after neoadjuvant therapy. Methods: The clinical data of 137 patients, including 111 males and 26 females, with the age of (M(QR))61(10) years (range: 45 to 75 years), undergoing radical resection of esophageal cancer after neoadjuvant therapy admitted at Department of Thoracic Surgery, West China Hospital from January 2016 to May 2019 were analyzed retrospectively. The blood routine one or two days before surgery and the occurrence of pneumonia after surgery were collected via hospital information system. The absolute count of neutrophils, lymphocytes and monocytes was recorded, to calculate NLR, LMR and NMR. The survival of patients was recorded systematically via follow-up. In the first part, the influencing factors of postoperative inflammation were analyzed, to group the patients into two groups according to the occurrence of postoperative pneumonia. χ2 test, t-test or rank-sum test were conducted for inter-group comparison. In the second part, cutoff values of inflammatory biomarkers were obtained with the receiver operating characteristic (ROC) curve and grouped, with postoperative pneumonia as endpoint criteria. Independent factors correlated with postoperative pneumonia were determined through univariate and multivariate Logistic regression analysis. In the third part, the analysis on prognosis factors was carried on, with the survival as endpoint criteria. Cutoff values of inflammatory biomarkers were obtained with X-Tile software and grouped. The survival analysis was carried on with univariate and multivariate Cox proportional hazards regression model, and the Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Median follow-up time was 614 (299) days (range: 382 to 1 612 days). Cutoff values of NLR, LMR, and NMR obtained via the ROC curve were 3.0, 3.9, and 6.2, respectively. According to the multivariate Logistic regression analysis, NLR>3.0 (OR=2.740, 95% CI: 1.221 to 6.152, P=0.015) and LMR>3.9 (OR=0.140, 95% CI: 0.022 to 0.890, P=0.037) were independent prognosis factors for postoperative pneumonia in patients with esophageal cancer after neoadjuvant therapy. Cutoff values of NLR, LMR, and NMR obtained with X-Tile software were 3.3, 4.2, and 7.2, respectively. Through multivariate Cox proportional risk regression analysis, late tumor ypTNM staging (8th AJCC) (HR=2.087, 95% CI:1.079 to 4.038, P=0.029), poor pathologic response (HR=2.251, 95% CI: 1.117 to 4.538, P=0.023), and LMR>4.2 (HR=0.347, 95% CI: 0.127 to 0.946, P=0.039) could be independent prognosis factors for overall survival. Kaplan-Meier survival analysis indicated that the overall survival of patients with LMR ≤4.2 was worse (P=0.002), with the 1-year overall survival rate of 82.9%, and the 1-year overall survival rate of patients with LMR>4.2 was 94.6%. Conclusion: Preoperative LMR ≤3.9 and NLR>3.0 can be considered as independent prognosis factors for postoperative pneumonia, while LMR≤4.2 as one of independent prognosis factors for overall survival.

High postoperative neutrophil-lymphocyte ratio and low preoperative lymphocyte-monocyte ratio predict poor prognosis in gastric cancer patients receiving gastrectomy with positive lavage cytology: a retrospective cohort study.

Long-term outcomes in gastric cancer patients with positive lavage cytology (CY1) are generally poor. This multi-institutional retrospective cohort study aims to evaluate the clinical significance of the neutrophil-lymphocyte ratio (NLR) and the lymphocyte-monocyte ratio (LMR) in CY1 gastric cancer patients. A total of 121 CY1 gastric cancer patients without other non-curative factors, who underwent macroscopically curative resection, were enrolled in this study. The cutoff values of preoperative NLR (pre-NLR), postoperative NLR (post-NLR), preoperative LMR (pre-LMR), and postoperative LMR (post-LMR) were defined by the Contal and O'Quigley method as 2.3, 3.0, 2.5, and 3.2, respectively. A Cox proportional hazard model was used to identify the independent prognostic factors among NLR, LMR, and other clinicopathological factors. There were significant differences in the overall survival (OS) between the two groups: high post-NLR groups vs. low post-NLR group (median survival time, months) (10.9 vs. 22.8, P = 0.006) and high pre-LMR group vs. low pre-LMR group (21.3 vs. 11.0, P = 0.001). The LMR value elevated significantly after gastrectomy (P = 0.020), although not in the NLR value (P = 0.733). On multivariate analysis, high post-NLR (hazard ratio = 1.506; 95% confidence interval = 1.047-2.167; P = 0.027), low pre-LMR (1.773; 1.135-2.769, 0.012), and no postoperative chemotherapy (1.558; 1.053-2.305, 0.027) were found to be independent prognostic factors for adverse OS. Because a combination of high post-NLR and low pre-LMR may be an adverse prognostic marker in resectable CY1 gastric cancer patients, it is necessary to conduct a prospective trial to confirm a useful perioperative chemotherapeutic regimen for these patients.

The Prognostic Value of Combined Preoperative and Postoperative Inflammation Indicators in Hepatocellular Carcinoma after Partial Hepatectomy

Purpose: The current clinical stage of hepatocellular carcinoma (HCC) is insufficient to predict the prognosis. Previous studies have shown that various preoperative inflammation indicators can predict the prognosis of HCC, but the role of postoperative inflammation indicators remains unclear. The purpose of this study was to explore the prognostic value of postoperative inflammation indicators and establish a clinical prognostic model combining preoperative and postoperative inflammation indicators. Methods: 88 patients with primary HCC from Beijing Tsinghua ChangGung Hospital in the National Hepatobiliary Standard Database were included in the study. Preoperative and postoperative prognostic models were established based on preoperative clinicopathological features and combined with postoperative inflammation indicators. The prognostic value of the four models was evaluated by the area under the curve of time-dependent receiver operating characteristic curves (td-AUC). Results: Multivariate analysis of preoperative clinicopathological indicators found that preoperative alpha-fetoprotein (AFP), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), Prognostic Nutritional Index (PNI), tumor number and microvascular invasion were independent prognostic factors for disease-free survival (DFS). Introducing the postoperative inflammatory indicators for multivariate analysis found that preoperative AFP, PLR, LMR, PNI and postoperative neutrophil-lymphocyte ratio (NLR) and PLR were independent prognostic factors for DFS and establish a postoperative model. The postoperative model had higher td-AUC values than the preoperative model, TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage in 1-year (0.849 VS 0.826, 0.514 and 0.532), 2-year (0.809 VS 0.799, 0.513 and 0.527), and 3-year (0.784 VS 0.783, 0.509 and 0.529) after surgery. Conclusions: Postoperative inflammation indicators are valuable prognostic indicators, and the predictive performance of the combined model is better than preoperative stage, TNM stage and BCLC stage.

Clinical and prognostic significance of preoperative lymphocyte-monocyte ratio, neutrophil-lymphocyte ratio and neutrophil-monocyte ratio on esophageal squamous cell carcinoma patients.

BackgroundThe interaction between tumor cells and inflammatory cells has not been systematically investigated in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to evaluate whether preoperative lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), and neutrophil-monocyte ratio (NMR) could predict the prognosis of ESCC patients undergoing esophagectomy.MethodsA total of 1,883 patients with histologically diagnosed ESCC who underwent radical esophagectomy from May 2005 to May 2015 were retrospectively reviewed. Besides clinicopathological factors, “Survminer” package in R® was applied to determine the optimal cut-off point for LMR, NLR and NMR. Meanwhile, we evaluated the prognostic value of LMR, NLR, and PLR using Kaplan-Meier curves and Cox regression models.ResultsThe median follow-up was 28.77 months (range, 1.60–247.90 months). The optimal cut-off point of LMR, NLR and NMR is 3.83, 2.06 and 7.21, respectively. Kaplan-Meier survival analysis of patients with low preoperative LMR demonstrated a significant worse prognosis for 5-year OS (P<0.001) than those with high preoperative LMR. The high NLR cohort had lower 5-year OS (P<0.001). No significant difference with 5-year OS was found in NMR (P=0.405). On multivariate analysis, preoperative LMR (P=0.018; HR =0.786, 95% CI: 0.645, 0.959) and NLR (P=0.028; HR =1.247, 95% CI: 1.024, 1.519) were the independent prognostic factors in ESCC patients. Integrating LMR and NLR, we divided the ESCC patients in four groups according to their cut-off points and we found the patients in LMR ≥3.83 and NLR <2.06 group received the best prognosis while the prognosis of patients in LMR<3.83 and NLR ≥2.06 group was the worst. The difference was statistically significant.ConclusionsPreoperative LMR and NLR better predicts cancer survival in patients with ESCC undergoing esophagectomy, especially under the circumstances of LMR ≥3.83 and NLR <2.06.

Preoperative lymphocyte-monocyte ratio is not an independent prognostic factor in M0 (stage I-III) esophageal squamous cell carcinomas.

BackgroundEsophageal carcinoma is an invasive malignancy with a poor prognosis. Inflammatory cells are related to the prognosis in many malignancies; however, the prognostic values of preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR) in esophageal squamous cell carcinomas (ESCCs) are contentious.MethodsWe performed a retrospective study on 178 patients who had proven ESCC and underwent R0 resection. A complete peripheral blood cell count on all patients 1 week before surgery was used to calculate NLR, LMR and PLR. All patients were grouped by the median count of NLR, LMR and PLR respectively. Kaplan-Meier curves were adopted to test the difference of overall survival (OS) and disease-free survival (DFS) between the high group of NLR, LMR and PLR and the low group. All data analysis was performed by SPSS. P<0.05 was assigned to admit statistical significance.ResultsThe median follow-up after the surgery was 39 months. The preoperative LMR showed no significant association with the OS [hazard ratio (HR) =0.733, 95% confidence interval (CI): 0.397–1.353, P=0.321] and DFS (HR =0.850, 95% CI: 0.491–1.473, P=0.562). Neither NLR nor PLR exhibited a significant correlation with OS or DFS.ConclusionsNLR, LMR, and PLR could not take the roles of prognostic biomarkers for patients with operable ESCCs.

Complete blood count-based inflammatory score (CBCS) is a novel prognostic marker for gastric cancer patients after curative resection

BackgroundWe sought to investigate the prognostic value of complete blood count (CBC)-based biomarkers for patients with resectable gastric cancer (GC).MethodsPatients with GC who underwent primary surgical resection between December 2008 and December 2013 were included. The estimated area under the curve (AUC) and multivariate Cox regression models were used to identify the best CBC-based biomarker. Time-dependent receiver operating characteristic (t-ROC) curve analysis was used to predict overall survival and compare the prognostic impact.ResultsIn the 1810 patients analyzed, the median follow-up period was 51.0 months (range 1–101 months). Based on multivariate analysis, the lymphocyte-monocyte ratio (LMR) and hemoglobin (Hb) level were independent prognostic factors (both P < 0.05). Based on the LMR and Hb level, we established the CBC-based inflammatory score (CBCS). A higher CBCS was associated with older age, female sex, higher American Society of Anesthesiologists (ASA) score, proximal tumor location, larger tumor size, later stage and vascular involvement (all P < 0.05). Univariate analyses showed that a higher CBCS was also associated with worse overall survival (OS), which was consistent in each stage (all P < 0.05). Multivariate analysis revealed that the CBCS was a significant independent biomarker (P < 0.05). The AUC for the CBCS (0.627) was significantly higher than the AUCs for the LMR (0.573) and Hb level (0.605) (both P < 0.05). Furthermore, the t-ROC curve of the CBCS was superior to that of the prognostic nutritional index (PNI), systemic immune-inflammation index (SII), modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin ratio (CRP/Alb) throughout the observation period.ConclusionThe preoperative LMR and Hb level were optimal CBC-based biomarkers for predicting OS in GC patients after curative resection. Based on the LMR and Hb, we developed a novel and easily obtainable prognostic score called the CBCS, which may improve the prediction of clinical outcomes.

Complete Blood Cell Count-Derived Inflammatory Biomarkers in Early-Stage Non-Small-Cell Lung Cancer.

Background: Complete blood cell count (CBC)-derived inflammatory biomarkers are widely used as prognostic parameters for various malignancies, but the best predictive biomarker for early-stage non-small-cell lung cancer (NSCLC) is unclear. We retrospectively analyzed early-stage NSCLC patients to investigate predictive effects of preoperative CBC-derived inflammatory biomarkers.Patients and Methods: We selected 311 consecutive patients with pathological stage IA NSCLC surgically resected from April 2006 to December 2012. Univariate and multivariate Cox proportional analyses of recurrence-free survival (RFS) were used to test the preoperative systemic immune inflammation index (SII), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and monocyte–lymphocyte ratio (MLR).Results: Preoperative high MLR levels were significantly associated with patient sex, smoking status, and postoperative recurrence (p <0.0001, p = 0.0307, and p = 0.0146, respectively), and preoperative high SII levels were significantly correlated with postoperative recurrence (p = 0.0458). Neither NLR nor PLR were associated with any related factors. Only preoperative MLR levels (p = 0.0269) were identified as an independent predictor of shorter RFS. The relative risk (RR) for preoperative high MLR level versus low level patients was 2.259 (95% confidence interval [CI]: 1.094–5.000). Five-year RFS rates in patients with preoperatively high MLR levels were significantly lower than in those with low MLR levels (82.21% vs. 92.05%, p = 0.0062). In subgroup analysis by tumor size and MLR level, the high MLR level subgroup with tumors >2 cm had significantly shorter RFS than other subgroups (p = 0.0289).Conclusions: The preoperative MLR level is the optimal predictor of recurrence in patients with pathological stage IA NSCLC.

1868 Prognostic Value of Preoperative Lymphocyte-Monocyte Ratio in Patients with Ovarian Clear Cell Carcinoma

Study Objective The aim of the present study was to determine the prognostic significances of markers of preoperative systemic inflammatory response (SIR) in patients with ovarian clear cell carcinoma (OCCC). Design A total of 109 patients diagnosed with OCCC that underwent primary cytoreductive surgery and adjuvant platinum-based chemotherapy from 2009 to 2012 were enrolled in this retrospective study. SIR markers were calculated from complete blood cell counts determined before surgery. Setting This study was performed in Pusan National University Hospital, Busan, Korea Patients or Participants 109 OCCC patients that had underwent primary debulking and adjuvant paclitaxel and carboplatin chemotherapy at university hospitals between April 2007 and June 2012. Interventions Preoperative blood samples were drawn 1 to 2 weeks prior to surgery. ROC curve analysis was used to obtain optimal NLR, LMR and PLR cutoff values for predicting survival outcomes. Measurements and Main Results The optimized NLR, LMR and PLR cut-off values as determined by ROC curve analysis for PFS and OS were 2.3, 4.2, and 123.6, respectively. When the cohort was divided using these optimized cut-offs, NLR and LMR were found to be significantly associated with clinicopathologic factors, NLR with FIGO stage, the presence of malignant ascites, and platinum response, and LMR with FIGO stage, lymph node metastasis, malignant ascites, and platinum response. Kaplan-Meier analysis revealed a high NLR (> 2.3) was significantly associated with low 5-year PFS and OS rates and that a high LMR was significantly associated with high 5-year PFS and OS rates. Multivariate analysis identified FIGO stage, residual mass, and platinum response as independent prognostic factors of PFS, and FIGO stage, residual mass, platinum response, and LMR as independent prognostic factors of OS. Conclusion Markers of systemic inflammatory response provide useful prognostic information and lymphocyte-to-monocyte ratio is the most reliable independent prognostic factor of overall survival in patients with ovarian clear cell carcinoma.

Prognostic significances of markers of preoperative preoperative lymphocyte-monocyte ratio in ovarian clear cell carcinoma patients

Objective: The aim of the present study was to determine the prognostic significance of markers of preoperative systemic inflammatory response (SIR) in patients with ovarian clear cell carcinoma (OCCC).

Preoperative lymphocyte count in relation to sarcoma prognosis.

Inflammation plays a major role in tumour development, progression and metastasis. Multiple inflammatory markers such as absolute lymphocyte count, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio have been discovered as prognostic markers for various malignancies. We investigate preoperative lymphocyte count and other cell count ratios and their relation to survival and prognosis of sarcoma patients after surgery. A total of 142 patients from the Orthopaedics Oncology Database were included into this retrospective study. Kaplan-Meier curve and multivariate Cox proportional models were used to calculate the overall survival of patients with sarcoma who underwent radical excision surgery. High preoperative LMR is significantly associated with better overall survival and prognosis in sarcoma patients, whereas high preoperative NLR is significantly associated with shorter overall survival and poorer prognosis. Multivariate analysis shows that LMR and NLR are good predictors for overall survival at 3 and 5 years after surgery, respectively. Patients with high preoperative lymphocytes count are associated with longer overall survival, but this association is not statistically significant. Our findings suggest that preoperative NLR and LMR are good predictive markers for survival of sarcoma patients. LMR and NLR can be used to identify patients at risk for poor clinical outcome, so that a more aggressive course of treatment can be applied to improve outcome. These are cost-effective prognostic tools as they are calculated from routine preoperative peripheral blood counts. In conclusion, preoperative NLR and LMR are good prognostic markers for predicting the clinical outcome of patients with sarcoma.

The evaluation of monocyte lymphocyte ratio as a preoperative predictor in urothelial malignancies: a pooled analysis based on comparative studies

In recent years, several studies have reported monocyte lymphocyte ratio (MLR) to predict prognosis in various tumors. Our study was performed to evaluate the association between preoperative MLR between prognostic variables in urothelial carcinoma patients. Systematic literature search was conducted in PubMed, Embase, Web of science. The correlation between preoperative MLR and overall survival (OS), cancer specific survival (CSS), disease free survival (DFS)/relapse free survival (RFS), progression free survival(PFS) was evaluated in urothelial carcinoma patients. Meanwhile, the association between MLR and clinicopathological characteristics was assessed. Finally, 12 comparative studies comprising a total of 6209 patients were included for pooled analysis. The hazard ratios (HRs), odds ratios (ORs)and 95% confidence intervals (CIs) were further analyzed as effect measures. The pooled results demonstrated that elevated preoperative MLR indicated unfavorable OS (HR = 1.29, 95%CI = 1.18-1.39, I2 = 33.6%), DFS/RFS (HR = 1.42, 95%CI = 1.30–1.55, I2 = 0.0%) and CSS (HR = 1.41, 95%CI = 1.29–1.52, I2 = 0.0%). Moreover, the pooled results also suggested that elevated preoperative MLR was correlated with high tumor stage (OR = 1.22, 95%CI = 1.07–1.37, I2 = 0.0%) in urothelial carcinoma patients. No significant association was found between preoperative MLR and PFS in upper urinary tract urothelial carcinoma (UUTUC) patients. Collectively, elevated preoperative MLR predicted poor prognosis in urothelial carcinoma and have the potential to be a feasible and cost-effective prognostic predictor for management of urothelial carcinoma.

Predictive value of preoperative monocyte-lymphocyte ratio among patients with localized clear renal cell carcinoma of ≤7 cm on preoperative imaging.

We investigated the prognostic ability of preoperative monocyte–lymphocyte ratio for oncologic outcomes in non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative computed tomography (CT).We retrospectively reviewed 1637 patients who underwent radical or partial nephrectomy for solid renal masses ≤7 cm (2005–2014). We included 1137 patients after exclusion of benign pathology, non-clear cell, morbidity affecting inflammatory markers, metastasis, regional lymphadenopathy, positive margin, and follow up <12 months. According to cutoff values of 0.21, we had high ≥0.21 and low <0.21 preoperative monocyte–lymphocyte ratio groups. Mann–Whitney U and chi-squared tests were used for continuous and Dichotomous variables. Univariate and multivariate Cox regression analysis were used to predict factors affecting recurrence and survival. Kaplan–Meier curve was used for survival analysis.At a median age of 56 years with a median follow up of 65 months, 51 patients had a recurrence (4.5%). There were no statistical differences between the high and low monocyte–lymphocyte ratio groups as regard the pathological characters (P > .005). Monocyte–lymphocyte ratio was a predictor for recurrence-free and cancer-specific survivals (hazard risk [HR] 2.17, P = .012 and HR 4.06, P = .004, respectively). A higher monocyte–lymphocyte ratio was significantly associated with worse, both 10-year recurrence-free (90.2% vs 94.9%) and cancer-specific survival (89.5% vs 98.8%) (Log-rank, P = .002 and P < .001, respectively).The preoperative monocyte–lymphocyte ratio is an independent prognostic marker for recurrence-free and cancer-specific survivals after curative surgery for non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative CT.

Correlation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and carcinoembrionic antigen level in colorectal cancer

Background: Colorectal cancer is one of cancer that has a high mortality rate. Cancer is associated with a systemic inflammatory response. Carcinoembryonic antigen (CEA) is a colorectal cancer prognostic marker, but this examination is quite expensive and not always ubiquitously available. Therefore, systemic inflammatory markers through routine blood examination are expected as a colorectal cancer marker. Objective: The present study is to determine a correlation of neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-monocyte ratio (LMR) and CEA level in colorectal cancer patients. Methods: This retrospective cross-sectional study was conducted in November 2016-January 2017 at Dr. Sardjito Hospital, Yogyakarta. As many as 209 patients who underwent surgery in January 2015-Decemberr 2016 with colorectal cancer histopathologic diagnosis were included. Demographic, clinical, histopathology and preoperative NLR, PLR, LMR and CEA level was obtained from medical records. Correlation of NLR, PLR, LMR and CEA level was analyzed with Somer’s test. Result: As many as 51.2% of subjects were male. Most subjects (n 42.6%) were diagnosed at 45-60 years old. The most common location of the tumor is in rectum (65.1%). Histopathology examination showed well differentiation in 51.7% subjects. The Somer’s analysis showed there was correlation of NLR and CEA level (p=0.023, r=0.164), there was a correlation between PLR and CEA level (p=0.016, r=0.146). Higher NLR and PLR was proportional to higher CEA level. There was a correlation of LMR and CEA level (p=0.001, r=-0.188), lower LMR correlates to higher CEA level. Conclusion: There is significant positive correlation of NLR and CEA level, PLR and CEA level, and negative correlation of LMR and CEA level in colorectal cancer patients.