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      The Lymphocyte-to-Monocyte Ratio is a Superior Predictor of Overall Survival in Comparison to Established Biomarkers of Resectable Colorectal Cancer

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          Abstract

          Objective:

          The study aims to investigate the prognostic value of the lymphocyte-to-monocyte ratio (LMR) in patients with colorectal cancer (CRC) undergoing curative resection and to compare it to established biomarkers including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow prognostic score (mGPS), and combined BRAF-mismatch repair (MMR) status.

          Background:

          The prognostic significance of systemic inflammatory markers in CRC such as the NLR, PLR, and mGPS has been well defined. Commonly used genetic markers such as combined BRAF-MMR status have also been found to be prognostic. Recent evidence, although limited, suggests that the preoperative LMR may be prognostic in CRC.

          Methods:

          Data from the Northern Sydney Local Health District from January 1998 to December 2012 were retrospectively collected. Of 3281 consecutive patients identified, 1623 patients who underwent curative resection were deemed eligible for inclusion. The relation between the LMR, clinicopathologic variables, and other biomarkers were analyzed in Kaplan-Meier log-rank survival analysis and then multivariate Cox regression models looking for association with overall survival (OS).

          Results:

          In multivariate analysis of all patients, elevated LMR was associated with better OS (hazard ratio 0.569, 95% confidence interval: 0.478–0.677, P < 0.001) independent of age ( P < 0.001), T stage ( P < 0.001), N stage ( P < 0.001), and grade ( P = 0.049). The NLR, PLR, and combined BRAF-MMR status were not independently significant. In multivariate subgroup analysis of 389 patients with mGPS, LMR remained the only independently significant biomarker (hazard ratio 0.620, 95% confidence interval: 0.437–0.880, P = 0.007).

          Conclusions:

          The LMR is an independent predictor of OS in patients with CRC undergoing curative resection and appears to be superior to pre-existing biomarkers.

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          The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer.

          Donald C. McMillan (2013)
          Since the initial work, a decade ago that the combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with cancer, there have been more than 60 studies (>30,000 patients) that have examined and validated the use of the GPS or the modified GPS (mGPS) in a variety of cancer scenarios. The present review provides a concise overview of these studies and comments on the current and future clinical utility of this simple objective systemic inflammation-based score. The GPS/mGPS had independent prognostic value in (a) unselected cohorts (4 studies, >19,400 patients) (b) operable disease (28 studies, >8,000 patients) (c) chemo/radiotherapy (11 studies, >1500 patients) (d) inoperable disease (11 studies, >2,000 patients). Association studies (15 studies, >2,000 patients) pointed to an increased GPS/mGPS being associated with increased weight and muscle loss, poor performance status, increased comorbidity, increased pro-inflammatory and angiogenic cytokines and complications on treatment. These studies have originated from 13 different countries, in particular the UK and Japan. A chronic systemic inflammatory response, as evidenced by the GPS/mGPS, is clearly implicated in the prognosis of patients with cancer in a variety of clinical scenarios. The GPS/mGPS is the most extensively validated of the systemic inflammation-based prognostic scores and therefore may be used in the routine clinical assessment of patients with cancer. It not only identifies patients at risk but also provides a well defined therapeutic target for future clinical trials. It remains to be determined whether the GPS has prognostic value in other disease states. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Neutrophil to lymphocyte ratio and cardiovascular diseases: a review.

            Tariq Bhat, Sumaya Teli, Jharendra Rijal … (2013)
            The role of inflammatory markers in cardiovascular diseases has been studied extensively and a consistent relationship between various inflammatory markers and cardiovascular diseases has been established in the past. Neutrophil to lymphocyte ratio (NLR) is a new addition to the long list of these inflammatory markers. NLR, which is calculated from complete blood count with differential, is an inexpensive, easy to obtain, widely available marker of inflammation, which can aid in the risk stratification of patients with various cardiovascular diseases in addition to the traditionally used markers. It has been associated with arterial stiffness and high coronary calcium score, which are themselves significant markers of cardiovascular disease. NLR is reported as an independent predictor of outcome in stable coronary artery disease, as well as a predictor of short- and long-term mortality in patients with acute coronary syndromes. It is linked with increased risk of ventricular arrhythmias during percutaneous coronary intervention (PCI) and higher long-term mortality in patients undergoing PCI irrespective of indications of PCI. In patients admitted with advanced heart failure, high NLR was reported with higher inpatient mortality. Recently, NLR has been reported as a prognostic marker for outcome from coronary artery bypass grafting and postcoronary artery bypass grafting atrial fibrillation.
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              Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer.

              Hyun Ji Julie Lee, Luke Oh, Dae-Hyun Kim … (2012)
              The objective of this study was to clarify whether the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are significant prognostic markers in patients with resectable colorectal cancer (CRC). A total of 200 patients who underwent curative resection for CRC were enrolled. The NLR and PLR were positively correlated (p < 0.001). Both the NLR and PLR were shown to be good prognostic biomarkers of overall survival (OS) (p=0.002 and p=0.001, respectively). The PLR was an independent prognostic factor of OS based on multivariate analysis (hazard ratio, 1.971; 95% confidence interval, 1.102-3.335; p=0.021).
              Article 0 comments Cited 139 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Surg
                Journal ID (iso-abbrev): Ann. Surg
                Journal ID (publisher-id): ANSU
                Title: Annals of Surgery
                Publisher: Lippincott, Williams, and Wilkins
                ISSN (Print): 0003-4932
                ISSN (Electronic): 1528-1140
                Publication date (Print): March 2017
                Publication date (Electronic): 08 April 2016
                Volume: 265
                Issue: 3
                Pages: 539-546
                Affiliations
                [∗ ]Bill Walsh Translational Research Laboratories, Kolling Institute of Medical Research, St Leonards, NSW, Australia
                [† ]Sydney Medical School, University of Sydney, Sydney, NSW, Australia
                [‡ ]Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
                [§ ]Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
                []Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia.
                Author notes
                Reprints: Stephen J. Clarke, MD, PhD, Level-1 Cancer Services, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia. E-mail: Stephen.clarke@ 123456sydney.edu.au .
                Article
                Publisher ID: D-15-02035 Accession ID: 00017
                DOI: 10.1097/SLA.0000000000001743
                PMC ID: 5300029
                PubMed ID: 27070934
                SO-VID: 6afc297c-022c-43df-ba7c-bbcdc78aec9a
                Copyright © Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

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                Subject: Original Articles
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                Keywords: braf mutation,colorectal cancer,lymphocyte-monocyte ratio,mismatch repair,modified glasgow prognostic score,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,prognosis,systemic inflammation
                Data availability:
                Keywords: braf mutation, colorectal cancer, lymphocyte-monocyte ratio, mismatch repair, modified glasgow prognostic score, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognosis, systemic inflammation

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