The Preoperative Lymphocyte to Monocyte Ratio Predicts Clinical Outcome In Resected Patients With T2-4N0-3M0 Siewert Type II/III Adenocarcinoma Of The Esophagogastric Junction

Abstract

Background Inflammation has a critical role in the pathogenesis and progression of cancer. The lymphocyte to monocyte ratio (LMR) could be a new biomarker in various tumors. Aims We analyzed the LMR with clinicopathological parameters and outcome in resected patients with T2-4N0-3M0 Siewert type II/III of advanced adenocarcinoma of the esophagogastric junction (AEG) . Methods A total of five hundred and seventy-one patients with Siewert type II/III of AEG between Jan 2006 and Jun 2012 were included in this retrospective study. Kaplan-Meier curves were used to calculate the cancer-specific survival (CSS). Univariate and multivariate Cox-regression analyses were performed to evaluate the prognostic factors. Results We set 3.64 as the cut-off level based on the receiver operating characteristic curve. The preoperative absolute lymphocyte count tended to decrease in ‘LMR≤3.64’ group, and the preoperative absolute monocyte count tended to decrease in ‘LMR＞3.64’ group. The decreased preoperative LMR was significantly associated with decreased CSS in univariate (HR:2.311, 95%CI:1.639-3.254, P=0.008) and multivariate analysis (HR:1.642, 95%CI:1.242-2.171, P=0.027 ). According to the treatment regimen(surgery alone versus surgery and adjuvant chemotherapy), no significant difference in the 5-year CSS was identified in ‘high-risk’ group (LMR≤3.64) (HR: 1.121, 95%CI: 0.733-1.725, P=0.605). Conclusions The LMR might be an independent prognostic marker for CSS in resected patients with T2-4N0-3M0 Siewert type II/III of advanced AEG. When the ‘high-risk’ patients with LMR≤3.64 were analyzed, no benefit of adjuvant 5-FU-based chemotherapy could be found.