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. 2017 Apr 12;8(45):79234-79247.
doi: 10.18632/oncotarget.17058. eCollection 2017 Oct 3.

Preoperative lymphocyte-to-monocyte ratio as a strong predictor of survival and recurrence for gastric cancer after radical-intent surgery

Jun-Peng Lin  1 , Jian-Xian Lin  1 , Long-Long Cao  1 , Chao-Hui Zheng  1 , Ping Li  1 , Jian-Wei Xie  1 , Jia-Bin Wang  1 , Jun Lu  1 , Qi-Yue Chen  1 , Mi Lin  1 , Ru-Hong Tu  1 , Chang-Ming Huang  1
Affiliations

Preoperative lymphocyte-to-monocyte ratio as a strong predictor of survival and recurrence for gastric cancer after radical-intent surgery

Jun-Peng Lin et al. Oncotarget. .

Abstract

Objectives: To evaluate the predictive value of the preoperative lymphocyte-to-monocyte ratio (LMR) for the prognosis of patients with gastric cancer (GC) after radical-intent surgery.

Methods: We retrospectively analyzed 1,810 patients who underwent radical-intent gastrectomy for primary GC from December 2008 to December 2013. X-tile software was used to identify the optimal value for blood LMR. Nomograms were developed to predict overall survival (OS) and recurrence-free survival (RFS) after surgery.

Results: LMR was significantly lower in patients with GC than in matched normal volunteers (P<0.001). As shown by forest plots, the long-term outcomes were poorer in the low LMR group than in the high LMR group when considering subgroups separated by clinical characteristics. Cox regression analysis showed that LMR was an independent prognostic factor for OS (P<0.001) and RFS (P=0.001). Nomograms, combining LMR with age, T stage, and N stage, showed better discriminative abilities than the AJCC staging system did in predicting 5-year survival and recurrence from the time of surgery. The recurrence rate was 30.4% (550/1810) and was significantly higher in the low LMR group than in the high LMR group (P<0.05). The LMR was also closely correlated with liver and lymph node metastases (both P<0.05).

Conclusion: As an independent prognostic factor for GC, preoperative LMR can improve the predictability of individual survival and recurrence. Furthermore, because liver and lymph node metastases were more commonly observed in patients with low blood LMR before surgery, these patients should be closely followed after the operation.

Keywords: gastric cancer; nomogram; overall survival; preoperative lymphocyte-to-monocyte ratio; recurrence.

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Conflict of interest statement

CONFLICTS OF INTEREST All of the authors declare that they have no potential commercial conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
X-tile analyses of 5-year OS (A) and RFS (B) performed using patient data to determine the optimal cut-off value for blood LMR. In the left panels, the X-axis represents all potential cut-off values from low to high (left to right) that define a low subset, whereas the Y-axis represents the cut-off values from high to low (top to bottom) that define a high subset. Red coloration of a cut-off value indicates an inverse correlation with time to recurrence, and green coloration represents direct associations. The optimal cut-off values highlighted by the black circles in the left panels are shown in the histograms of the entire cohort (middle panels). Kaplan-Meier plots are displayed in the right panels, where blue represents the low subgroup and gray represents the high subgroup. The optimal cut-off value for blood LMR is 3.15 for both OS and RFS.
Figure 2
Figure 2. Blood cell counts from normal volunteers and patients with GC
(A) There was no significant difference in age and gender between NVs and patients with GC (both P>0.05). (B) The blood LMR in patients with GC was significantly lower than that in NVs (4.51±0.05 vs. 5.26±0.06, P<0.05). (C) The monocyte counts in patients with GC were significantly higher than those in NVs (0.44±0.46 vs. 0.38±0.01, P<0.05). (D) The lymphocyte counts of GC patients were significantly lower than those of the NVs (1.78±0.02vs 1.96±0.02, P<0.05).
Figure 3
Figure 3. Forest plot showing OS and RFS according to subgroup effects
Figure 4
Figure 4
Nomogram to estimate the probability of OS (A) and RFS (B) at 3 and 5 years.
See this image and copyright information in PMC

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