The Lymphocyte-to-Monocyte Ratio is a Superior Predictor of Overall Survival in Comparison to Established Biomarkers of Resectable Colorectal Cancer.
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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DOI：
10.1097/sla.0000000000001743
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发表时间：
2017-03
影响因子：
9
通讯作者：
Clarke SJ
中科院分区：
文献类型：
--
作者：
Chan JC;Chan DL;Diakos CI;Engel A;Pavlakis N;Gill A;Clarke SJ
该研究旨在探讨淋巴细胞与单核细胞比率（LMR）在接受根治性切除的结直肠癌（CRC）患者中的预后价值，并将其与已建立的生物标志物进行比较，包括中性粒细胞与淋巴细胞比率（NLR）、血小板与淋巴细胞比率（PLR）、改良格拉斯哥预后评分（mGPS）和braf -错配修复（MMR）组合状态。系统性炎症标志物如NLR、PLR和mGPS在结直肠癌中的预后意义已经得到了很好的定义。常用的遗传标记如BRAF-MMR联合状态也被发现具有预后作用。最近的证据，虽然有限，表明术前LMR可能是CRC的预后。回顾性收集1998年1月至2012年12月北悉尼地方卫生区的数据。在确定的3281例连续患者中，1623例接受根治性切除的患者被认为符合纳入条件。通过Kaplan-Meier log-rank生存分析分析LMR、临床病理变量和其他生物标志物之间的关系，然后通过多变量Cox回归模型寻找与总生存期（OS）的关联。在所有患者的多因素分析中，LMR升高与更好的OS相关（风险比0.569,95%可信区间：0.478-0.677,P < 0.001），与年龄（P < 0.001）、T期（P < 0.001）、N期（P < 0.001）和分级（P = 0.049）无关。NLR、PLR和BRAF-MMR联合状态独立无显著性。在389例mGPS患者的多变量亚组分析中，LMR仍然是唯一独立显著的生物标志物（风险比0.620,95%可信区间：0.437-0.880,P = 0.007）。LMR是行根治性切除的结直肠癌患者OS的独立预测指标，似乎优于已有的生物标志物。
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. 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. 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). 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). The LMR is an independent predictor of OS in patients with CRC undergoing curative resection and appears to be superior to pre-existing biomarkers.