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. 2023 Feb 8;15(4):1080.
doi: 10.3390/cancers15041080.

Systemic Inflammatory Indices in Second-Line Soft Tissue Sarcoma Patients: Focus on Lymphocyte/Monocyte Ratio and Trabectedin

Valentina Fausti  1 , Alessandro De Vita  2 , Silvia Vanni  2 , Virginia Ghini  1 , Lorena Gurrieri  1 , Nada Riva  1 , Roberto Casadei  3 , Marco Maraldi  3 , Giorgio Ercolani  4 , Davide Cavaliere  4 , Carlo Alberto Pacilio  4 , Federica Pieri  5 , Flavia Foca  6 , Alberto Bongiovanni  1 , Nicoletta Ranallo  1 , Sebastiano Calpona  1 , Giovanni Luca Frassineti  7 , Toni Ibrahim  8 , Laura Mercatali  2
Affiliations

Systemic Inflammatory Indices in Second-Line Soft Tissue Sarcoma Patients: Focus on Lymphocyte/Monocyte Ratio and Trabectedin

Valentina Fausti et al. Cancers (Basel). .

Abstract

A second-line standard of treatment has not yet been identified in patients with soft tissue sarcomas (STS), so identifying predictive markers could be a valuable tool. Recent studies have shown that the intratumoral and inflammatory systems significantly influence tumor aggressiveness. We aimed to investigate prognostic values of pre-therapy neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory index (SII), progression-free survival (PFS), and overall survival (OS) of STS patients receiving second-line treatment. In this single-center retrospective analysis, ninety-nine patients with STS were enrolled. All patients received second-line treatment after progressing to anthracycline. PFS and OS curves were calculated using the Kaplan-Meier method of RNA sequencing, and CIBERSORT analysis was performed on six surgical specimens of liposarcoma patients. A high NLR, PLR, and SII were significantly associated with worse PFS (p = 0.019; p = 0.004; p = 0.006). Low LMR was significantly associated with worse OS (p = 0.006). Patients treated with Trabectedin showed a better PFS when the LMR was low, while patients treated with other regimens showed a worse PFS when the LMR was low (p = 0.0154). The intratumoral immune infiltrates analysis seems to show a correlation between intratumoral macrophages and LMR. PS ECOG. The metastatic onset and tumor burden showed prognostic significance for PFS (p = 0.004; p = 0.041; p = 0.0086). According to the histologies, PFS was: 5.7 mo in liposarcoma patients vs. 3.8 mo in leiomyosarcoma patients vs. 3.1 months in patients with other histologies (p = 0.053). Our results confirm the prognostic role of systemic inflammatory markers in patients with STS. Moreover, we demonstrated that LMR is a specific predictor of Trabectedin efficacy and could be useful in daily clinical practice. We also highlighted a possible correlation between LMR levels and the percentage of intratumoral macrophages.

Keywords: lymphocyte-to-monocyte ratio; metastatic soft tissue sarcoma; prognostic marker; systemic inflammation marker; tumor microenvironment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PFS according to (A) tumor burden; (B) PS ECOG; (C) metastatic onset; (D) histology.
Figure 2
Figure 2
PFS according to (A) NLR, (B) PLR, and (C) SII.
Figure 3
Figure 3
Overall survival according to LMR.
Figure 4
Figure 4
Progression-free survival according to LMR and treatment (Trabectedin vs. others).
Figure 5
Figure 5
CIBESORT analysis of immune intratumoral populations and relative specific percentage.
See this image and copyright information in PMC

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