Lymphocyte-to-monocyte ratio can predict mortality in pancreatic adenocarcinoma

AIM To determine if the lymphocyte-to-monocyte ratio(LMR) could be helpful in predicting survival in patients with pancreatic adenocarcinoma.METHODS We retrospectively reviewed the medical records of all patients diagnosed with pancreatic adenocarcinoma in the VA North Texas Healthcare System from January 2005 to December 2010. The LMR was calculated from peripheral blood cell counts obtained at the time of diagnosis of pancreatic cancer by dividing the absolute lymphocyte count by the absolute monocyte count. A Univariable Cox regression analysis was performed using these data, and hazard ratios(HR) and 95%CI were calculated. The median LMR(2.05) was used to dichotomize patients into high-LMR and low-LMR groups and the log rank test was used to compare survivalbetween the two groups.RESULTS We identified 97 patients with pancreatic adenocarcinoma(all men, 66% white, 30% African-American). The mean age and weight at diagnosis were 66.0 ± 0.9(SEM) years and 80.4 ± 1.7 kg respectively. Mean absolute lymphocyte and monocyte values were 1.50 ± 0.07 K/mL and 0.74 ± 0.03 K/mL respectively. Mean, median and range of LMR was 2.36, 2.05 and 0.4-12 respectively. In the univariable Cox regression analysis, we found that an increased LMR was a significant indicator of improved overall survival in patients with pancreatic adenocarcinoma(HR = 0.83; 95%CI: 0.70-0.98; P = 0.027). Kaplan-Meier analysis revealed an overall median survival of 128 d(95%CI: 80-162 d). The median survival of patients in the high-LMR(> 2.05) group was significantly greater than the low-LMR group(≤ 2.05)(194 d vs 93 d; P = 0.03), validating a significant survival advantage in patients with a high LMR.CONCLUSION The LMR at diagnosis is a significant predictor for survival and can provide useful prognostic information in the management of patients with pancreatic adenocarcinoma.

Neutrophile-to-lymphocyte,lymphocyte-to-monocyte,and platelet-tolymphocyte ratios as prognostic and response biomarkers for resectable locally advanced gastric cancer

BACKGROUND Perioperative fluorouracil plus leucovorin,oxaliplatin,and docetaxel(FLOT)improves prognosis in locally advanced gastric cancer(LAGC).Neutrophil-to-lymphocyte(NLR),lymphocyte-tomonocyte(LMR),and platelet-to-lymphocyte(PLR)ratios are prognostic biomarkers but not predictive factors.AIM To assess blood ratios’(NLR,LMR and PLR)potential predictive response to FLOT and survival outcomes in resectable LAGC patients.METHODS This was a multicentric retrospective study investigating the clinical potential of NLR,LMR,and PLR in resectable LAGC patients,treated with at least one preoperative FLOT cycle,from 12 Portuguese hospitals.Means were compared through non-parametric Mann-Whitney tests.Receiver operating characteristic curve analysis defined the cut-off values as:High PLR>141 for progression and>144 for mortality;high LMR>3.56 for T stage regression(TSR).Poisson and Cox regression models the calculated relative risks/hazard ratios,using NLR,pathologic complete response,TSR,and tumor regression grade(TRG)as independent variables,and overall survival(OS)as the dependent variable.RESULTS This study included 295 patients(mean age,63.7 years;59.7% males).NLR was correlated with survival time(r=0.143,P=0.014).PLR was associated with systemic progression during FLOT(P=0.022)and mortality(P=0.013),with high PLR patients having a 2.2-times higher risk of progression[95% confidence interval(CI):0.89-5.26]and 1.5-times higher risk of mortality(95%CI:0.92-2.55).LMR was associated with TSR,and high LMR patients had a 1.4-times higher risk of achieving TSR(95%CI:1.01-1.99).OS benefit was found with TSR(P=0.015)and partial/complete TRG(P<0.001).Patients without TSR and with no evidence of pathological response had 2.1-times(95%CI:1.14-3.96)and 2.8-times(95%CI:1.6-5)higher risk of death.CONCLUSION Higher NLR is correlated with longer survival time.High LMR patients have a higher risk of decreasing T stage,whereas high PLR patients have higher odds of progressing under FLOT and dying.Patients with TSR and a pathological response have better OS and lower risk of dying.

The combined prognostic value of pretreatment neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in stage IE/IIE extranodal natural killer/T-cell lymphoma

Objective This study aimed to explore the combined prognostic value of pretreatment neutrophil-tolymphocyte ratio(NLR), lymphocyte-to-monocyte ratio(LMR), and platelet-to-lymphocyte ratio(PLR) in newly diagnosed IE/IIE extranodal natural killer/T-cell lymphoma(ENKTL) treated with a P-Gemox regimen combined with radiotherapy or radiotherapy alone.Methods A total of 132 patients from 2009 to 2017 at the Sichuan Cancer Hospital were enrolled in the study. The cutoff values of NLR, LMR, and PLR using overall survival(OS) rate as an endpoint were obtained by the receiver operating curve. Results The cutoff value of NLR was 3.5. Patients with high NLR had significantly shorter progressionfree survival(PFS)(P < 0.001) and OS(P < 0.001) than those with low NLR. Similarly, the cutoff value of LMR was 3.0. The high LMR group had significantly longer PFS(P=0.001) and OS(P < 0.001) than the low LMR group. Similarly, the cutoff value of PLR was 191.7. The high PLR group was significantly associated with poor PFS(P < 0.001) and OS(P < 0.001) than the low PLR group. Furthermore, combining NLR, LMR, and PLR to build a new model to stratify patients into low-, intermediate-, intermediate-high-, and high-risk groups, there were also significant differences in PFS(P < 0.001) and OS(P < 0.001). The univariate analysis showed that presenting B symptoms, stage IIE, local tumor invasion, Eastern Cooperative Oncology Group score ≥ 2, elevated lactate dehydrogenase level, elevated NLR, decreased LMR, and elevated PLR were significantly associated with poor survival. The multivariate analysis demonstrated that PLR was an independent prognostic factor for both PFS(hazard ratio [HR]= 2.073, 95% confidence interval [CI]= 1.080–3.981, P = 0.028) and OS(HR = 2.127, 95% CI = 1.102–4.107, P = 0.025).Conclusion Elevated pretreatment PLR was a novel simple predictor of poor survival in patients with stage IE/IIE ENKTL. Combining NLR, LMR, and PLR could provide additional stratification.

Development and validation of a nomogram including lymphocyte-to-monocyte ratio for initial prostate biopsy:a double-center retrospective study

Here,we developed a prostate cancer(PCa)risk nomogram including lymphocyte-to-monocyte ratio(LMR)for initial prostate biopsy,and internal and external validation were further conducted.A prediction model was developed on a training set.Significant risk factors with P<0.10 in multivariate logistic regression models were used to generate a nomogram.Discrimination,calibration,and clinical usefulness of the model were assessed using C-index,calibration plot,and decision curve analysis(DCA).The nomogram was re-examined with the internal and external validation set.A nomogram predicting PCa risk in patients with prostate-specific antigen(PSA)4-10 ng ml^(-1)was also developed.The model displayed good discrimination with C-index of 0.830(95%confidence interval[Cl]:0.812-0.852).High C-index of 0.864(95%Cl:0.840-0.888)and 0.871(95%Cl:0.861-0.881)was still reached in the internal and external validation sets,respectively.The nomogram exhibited better performance compared to the nomogram with PSA only(C-index:0.763,95%Cl:0.746-0.780,P<0.001)and the nomogram with LMR excluded(C-index:0.824,95%Cl:0.804-0.844,P<0.010).The calibration curve demonstrated good agreement in the internal and external validation sets.DCA showed that the nomogram was useful at the threshold probability of>4%and<99%.The nomogram predicting PCa risk in patients with PSA 4-10 ng ml^(-1)also displayed good calibration and discrimination performance(C-index:0.734,95%Cl:0.708-0.760).This nomogram incorporating age,PSA,digital rectal examination,abnormal imaging signals,PSA density,and LMR could be used to facilitate individual PCa risk prediction in initial prostate biopsy.

Lymphocyte-to-monocyte ratio is a short-term predictive marker of ulcerative colitis after induction of advanced therapy

Advanced therapies for patients with mild-to-severe ulcerative colitis(UC)may result in treatment failure.We examined whether the lymphocyte-to-monocyte ratio(L/M ratio)could predict the failure of advanced therapies.This retrospective,observational,cohort study included 73 patients who were treated with advanced therapies at the Hamamatsu University School of Medicine(Shizuoka,Japan)between February 2011 and November 2020.The patients were divided into the nonfailure and failure groups,and their leukocyte counts and ratios before induction were examined.Univariate and multivariate analyses were performed to identify the prognostic factors.Advanced therapies failed within 3 months in 15(20.5%)patients.Only the L/M ratio was significantly lower in the failure group than in the non-failure group(P=0.004).Receiveroperating characteristic(ROC)curve analysis revealed that an L/M ratio of ≤3.417 was predictive of treatment failure;the area under the curve(AUC)was 0.747(95%CI,0.620–0.874).Kaplan–Meier analysis revealed that the failure-free rate was significantly lower in the group with an L/M ratio of≤3.417 than in the group with an L/M ratio of>3.417(log-rank test P=0.002).Cox proportional hazard regression analysis identified an L/M ratio of≤3.417 as an independent risk factor for failure within 3 months after the induction of advanced therapies.Furthermore,ROC analysis of patients who did not receive immunomodulators also revealed that the cut-off L/M ratio was 3.417 and the AUC was 0.796(95%CI,0.666–0.925).In patients receiving advanced therapies for active UC,the L/M ratio can predict treatment failure within 3 months.L/M ratios could facilitate the transition from advanced therapies to subsequent treatments.

Feasibility of lymphocyte-to-monocyte ratio in predicting no-reflow phenomenon in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

BACKGROUND Platelet count or complete blood count(CBC)-based ratios including lymphocyteto-monocyte(LMR),neutrophil-to-lymphocyte(NLR),hemoglobin-to-platelet(HPR),red blood cell count distribution width-to-platelet(RPR),and platelet-tolymphocyte(PLR)ratio are good predictors of colorectal cancer(CRC)survival.Their change in time is not well documented,however.AIM To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties,comorbidities,and anamnestic data.METHODS A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients,who attended at Semmelweis University,Budapest.CBC ratios and two additional newly defined personalized platelet count metrics(pPLT_(D)and pPLT_(S),the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery,respectively)were recorded.RESULTS The 835 CRC patients had a total of 4608 measurements(5.52 visits/patient,in average).Longitudinal survival models revealed that the increases/decreases in LMR[hazard ratio(HR):0.4989,P<0.0001],NLR(HR:1.0819,P<0.0001),HPR(HR:0.0533,P=0.0038),pPLT_(D)(HR:4.9229,P<0.0001),and pPLT_(S)(HR:4.7568,P<0.0001)values were poor prognostic signs of disease-specific survival.The same was obtained for all-cause mortality.Most abnormal changes occurred within the first 3 years after the diagnosis of CRC.RPR and PLR had an only marginal effect on diseasespecific(P=0.0675)and all-cause mortality(Bayesian 95%credible interval:0.90–186.05),respectively.CONCLUSION LMR,NLR,and HPR are good metrics to follow the prognosis of the disease.pPLT_(D)and pPLT_(S)perform just as well as the former,while the use of RPR and PLR with the course of the disease is not recommended.Early detection of the abnormal changes in pPLT_(D),pPLT_(S),LMR,NLR,or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.