Preoperative lymphocyte-to-monocyte ratio represents a superior predictor compared with neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for colorectal liver-only metastases survival

Abstract

Systemic inflammation was recognized as an essential factor contributing to the development of malignancies. This study aimed to investigate the prognostic value of pre-operative lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with colorectal liver-only metastases (CLOM) undergoing hepatectomy. We retrospectively enrolled 150 consecutive patients with CLOM between 2000 and 2012. The optimal cutoff values of continuous LMR, NLR, and PLR were determined using the receiver operating characteristic curve analysis. Recurrence-free survival (RFS) and overall survival (OS) related to the LMR, NLR, and PLR were analyzed using both Kaplan–Meier and multivariate Cox regression methods. Elevated LMR (≥2.82) and lower NLR (<4.63) were significantly associated with better RFS and OS in patients with CLOM after hepatectomy, instead of lower PLR (<150.17). Multivariate Cox analysis identified elevated LMR as the only independent inflammatory factor for better RFS (hazard ratio, 0.591; 95% CI, 0.32–0.844; P=0.008) and OS (hazard ratio, 0.426; 95% CI, 0.254–0.716; P=0.001). In the subgroup analysis, elevated LMR was a significant favorable factor in both 5-year RFS and OS of patients with male gender, lymph node metastases, colon cancer, liver tumor with the largest diameter <5 cm, preoperative carcinoembryonic antigen level <200 ng/mL, negative hepatitis B virus infection, non-anatomic liver resection, postoperative chemotherapy, and non-preoperative chemotherapy. This study demonstrated that the preoperative LMR was an independent predictor of RFS and OS in patients with CLOM undergoing hepatic resection, and it appeared to be superior to the NLR and PLR.

Association of peripheral blood cell count-derived ratios, biomarkers of inflammatory response and tumor growth with outcome in previously treated metastatic colorectal carcinoma patients receiving cetuximab

“…Thus, laboratory parameters of lymphocyte presence in the periphery could represent important prognostic and predictive biomarkers that could be used in guiding therapeutic decisions. The prognostic significance of PBC-derived ratios has been amply documented in both early and advanced colorectal cancer [13][14][15]. In the present study, NLR was a significant predictor of prognosis in univariate analysis, but in multivariate analysis, hemoglobin was the only hematological parameter independently predicting prognosis, possibly because of the limited size of the cohort.…”

“…In the present study, NLR was a significant predictor of prognosis in univariate analysis, but in multivariate analysis, hemoglobin was the only hematological parameter independently predicting prognosis, possibly because of the limited size of the cohort. This is in contrast to some other studies [13][14][15]. These apparently conflicting results could be related to the size of the cohort, setting (early versus advanced metastatic disease), selection of the end-point (overall survival versus recurrence-free survival) and also the selection of the parameters investigated.…”

“…However, it has been demonstrated during the past few years that relative lymphocyte numbers in the peripheral blood expressed as a ratio to other blood elements are also a powerful biomarker predictive of patient prognosis, again across a range of tumor types. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory index (SII) have been shown to predict outcome in different solid tumors, including colorectal carcinoma [7][8][9][10][11][12][13][14][15].…”

Predicting complications in hepatic resection for colorectal liver metastasis: the lymphocyte‐to‐monocyte ratio

“…16 Nevertheless, any potential benefit that could be gleaned from earlier detection of post-operative complications could offer improved patient outcomes. A body of work has demonstrated that the LMR may be a prognostic marker in CLM; [23][24][25] however, the potential link between LMR and predicting complications following hepatic resection for CLM has not been previously elucidated. Previous studies have demonstrated that combined serum parameters, such as the neutrophil-tolymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR), may be more effective at detecting post-operative complications as opposed to traditional parameters, such as white blood cell count (WCC) and C-reactive protein (CRP).…”

“…[19][20][21][22] Theoretically, a low LMR could be correlated with adverse outcomes. A body of work has demonstrated that the LMR may be a prognostic marker in CLM; [23][24][25] however, the potential link between LMR and predicting complications following hepatic resection for CLM has not been previously elucidated. We therefore sought to identify whether there was a link between LMR and the detection of post-operative complications following hepatic resection for CLM.…”