The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas
The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas
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DOI：
10.1002/ijc.28677
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发表时间：
2014-07-15
影响因子：
6.4
通讯作者：
Pichler, Martin
中科院分区：
文献类型：
--
作者：
Szkandera, Joanna;Gerger, Armin;Pichler, Martin
越来越多的证据表明炎症和凝血参与癌症进展和转移。炎症生物标志物对于提高癌症患者现有预后工具的预测能力具有很大的希望。在本研究中，我们调查了几个炎症指标的预后相关性预测软组织肉瘤（STS）患者的临床结果。将340例STS患者分为训练集（n=170）和验证集（n=170）。除了确定的临床病理预后因素外，我们还使用Kaplan-Meier曲线和单变量以及多变量考克斯回归模型评估了中性粒细胞/淋巴细胞（N/L）比值、淋巴细胞/单核细胞（L/M）比值和血小板/淋巴细胞（P/L）比值的预后价值。此外，我们开发了一个诺模图，通过补充L/M比，以完善的Kendrim诺模图，并通过应用校准和Harrell的一致性指数（C-指数），评估这种新的诺模图的预测精度。在多变量分析中，低L/M比与训练集中CSS和DFS降低显著相关（分别为HR=0.41，95% CI=0.18-0.97，p=0.043; HR=0.39，95% CI=0.16-0.91，p=0.031）。使用验证集进行确认，我们还在多变量分析中发现CSS（HR=0.33，95%CI =0.12-0.90，p=0.03）和DFS（HR=0.36，95%CI =0.16-0.79，p=0.01）的独立值。使用原始Kynomogram估计的c指数为0.74，当加入L/M比时为0.78。我们的研究首次报道了术前L/M比值是预测STS患者临床结局的一个新的独立预后因素。这种易于确定的生物标志物可能有助于改善个体风险评估。随着越来越多的证据表明炎症和凝血参与癌症进展和转移，炎症生物标志物有望提高现有预后工具的预测能力。本研究首次报道了术前淋巴细胞/单核细胞（L/M）比值是预测软组织肉瘤（STS）患者临床结局的一个新的独立预后因素。这种易于确定的生物标志物可能有助于改善个体风险评估和患者分层。此外，用L/M比值补充Kynomogram--一种成熟的预测肉瘤特异性死亡的术后预后模型--提高了这种预后工具的预测能力。
Increasing evidence indicates the involvement of inflammation and coagulation in cancer progression and metastases. Inflammatory biomarkers hold great promise for improving the predictive ability of existing prognostic tools in cancer patients. In the present study, we investigated several inflammatory indices with regard to their prognostic relevance for predicting clinical outcome in soft tissue sarcoma (STS) patients. Three hundred and forty STS patients were divided into a training set (n=170) and a validation set (n=170). Besides well-established clinico-pathological prognostic factors, we evaluated the prognostic value of the neutrophil/lymphocyte (N/L) ratio, the lymphocyte/monocyte (L/M) ratio and the platelet/lymphocyte (P/L) ratio using Kaplan-Meier curves and univariate as well as multivariate Cox regression models. Additionally, we developed a nomogram by supplementing the L/M ratio to the well-established Kattan nomogram and evaluated the predictive accuracy of this novel nomogram by applying calibration and Harrell's concordance index (c-index). In multivariate analysis, a low L/M ratio was significantly associated with decreased CSS and DFS (HR=0.41, 95% CI=0.18-0.97, p=0.043; HR=0.39, 95% CI=0.16-0.91, p=0.031, respectively) in the training set. Using the validation set for confirmation, we found also in multivariate analysis an independent value for CSS (HR=0.33, 95% CI=0.12-0.90, p=0.03) and for DFS (HR=0.36, 95% CI=0.16-0.79, p=0.01). The estimated c-index was 0.74 using the original Kattan nomogram and 0.78 when the L/M ratio was added. Our study reports for the first time that the pre-operative L/M ratio represents a novel independent prognostic factor for prediction the clinical outcome in STS patients. This easily determinable biomarker might be helpful in improved individual risk assessment.What's new? With increasing evidence of the involvement of inflammation and coagulation in cancer progression and metastases, inflammatory biomarkers hold great promise for improving the predictive ability of existing prognostic tools. This study reports for the first time that the pre-operative lymphocyte/monocyte (L/M) ratio represents a novel independent prognostic factor for prediction of clinical outcome in soft tissue sarcoma (STS) patients. This easily determinable biomarker might be helpful in improving individual risk assessment and patient stratification. Furthermore, supplementing the Kattan nomogram-a well-established postoperative prognostic model that predicts sarcoma-specific death-with the L/M ratio improved the predictive ability of such prognostic tool.