Prognostic role of the lymphocyte‐to‐monocyte ratio for clinical outcomes of patients with progressive radioiodine‐refractory differentiated thyroid carcinoma treated by sorafenib

Abstract

Objectives:The lymphocyte-to-monocyte ratio (LMR) reflects the status of tumourinfiltrating immune cells and host immunity. The LMR has been reported as a prognostic marker in various cancers. The present study evaluated the role of the LMR as a prognostic marker in patients with progressive radioiodine-refractory (RAIR) differentiated thyroid carcinoma (DTC). Design: Retrospective cohort study.Patients: Forty patients with progressive RAIR DTC who were treated by sorafenib with available baseline complete blood cell count data. Measurements:We assessed the response rate, progression-free survival (PFS) and overall survival (OS). Results:The patients were divided into low and high LMR groups based on their baseline LMRs (<4, n = 22, 55% and ≥4, n = 18, 45%, respectively). There were no significant differences in baseline characteristics between the groups. The OS curves differed significantly based on the LMR. The median OS of the low LMR group was 24.3 months and that of the high LMR group was not reached until the end of observation period (P = .015). The PFS curves and median PFS also differed significantly based on the LMR values (P = .019). In multivariate analysis, low LMR was an independent risk factor for all-cause mortality in patients with progressive RAIR DTC (hazard ratio, 2.64; 95% confidence interval: 1.04-6.72, P = .041). Conclusion:A low LMR was associated with poor response rate, PFS and OS in patients with progressive RAIR DTC treated with sorafenib. Thus, LMR could be a simple prognostic biomarker in patients with progressive RAIR DTC. K E Y W O R D Sdifferentiated thyroid carcinoma, immune system, lymphocyte, monocytes, sorafenib

The systemic immune-inflammation index-based model is an effective biomarker on predicting central lymph node metastasis in clinically nodal-negative papillary thyroid carcinoma

“…A few studies showed that preoperative levels of NLR and PLR were associated with poorer survival and recurrence data of PTC (17,18). There were also some studies showing that PTC patients with a lower LMR had a poorer prognosis and a higher risk of recurrence (19)(20)(21). Besides, advanced tumor stage of PTC was found to be associated with a higher NLR and a lower LMR (22)(23)(24).…”

Serum Inflammation-based Scores in Endocrine Tumors

“…A lower LMR has been correlated to advanced staged PTC ( 52 , 58 ). Low LMR was also associated with decreased overall and disease-free survival ( 58 ), including in patients with DTC refractory to radioiodine and treated with sorafenib ( 59 ), with LMR < 4 predicting shorter survival ( 58 , 59 ). A different study correlated a low LMR with recurrence, especially in patients with advanced PTC (stages II and III), with an optimal cut-off of 5 ( 61 ).…”

“…Song et al reported an association between lower LMR and larger tumors, multifocality and lymph node metastasis ( 58 ), other studies found no correlation between LMR and lymph node metastasis ( 52 , 61 ). More studies are needed to further assess the LMR usefulness in thyroid cancer, but LMR may be a promising tool in predicting recurrence and survival in patients with high-risk, advanced, or refractory PTC ( 58 , 59 , 61 ).…”

Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer

“…6) [58] and RAIR DTC patients treated with sorafenib (Fig. 7) [59]. A low LMR might be a reflection of both lymphopenia, which is a marker of weak immunity, and an elevated monocyte count in Copyright © 2020 Korean Endocrine Society the peripheral blood, which reflects elevated tumor-associated macrophage density in cancer tissue (corresponding to favorable conditions for tumor progression) [60].…”