Welcome to Francis Academic Press

Academic Journal of Medicine & Health Sciences, 2024, 5(5); doi: 10.25236/AJMHS.2024.050510.

Lymphocyte-to-Monocyte Ratio: A Simple and Effective Inflammation Marker in Predicting Mortality of Non-Institutionalized Americans with Cancers

Author(s)

Lei Yang1, Xiaohe Sun2, Shuai Chen1, Hua Shao1

Corresponding Author:
Hua Shao
Affiliation(s)

1The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China

2Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China

Abstract

Cancer is a serious disease with a high mortality rate. In view of the urgent need of prognosis, the lymphocyte-to-monocyte ratio (LMR) may be a promising cancer marker, but the evidence is weak. Accordingly, we evaluated the clinical impact of LMR based on the Health and Nutrition Examination Survey (NHANES) data. An overall sample of 2363 cancer patients was studied. Based on the Cox proportional hazards model, we examined the relationship between LMR and all-cause mortality. The Kaplan-Meier (KM) analysis assessed the predictive power of LMR for cancer prognosis in comparison to Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR). In addition, extra subgroup analyses and sensitivity analyses were carried out to examine the robust of the outcomes. After accounting for multiple covariates, LMR was associated with mortality for all-causes among cancer patients. In Kaplan-Meier survival curves, mortality rate was significantly elevated among low-LMR group versus high-LMR group (Log rank test P < 0.001). Multiple regression analyses revealed the same result that LMR in continuous or categorical variables were respectively associated with the risk of all-cause mortality in participants with cancer (P <0.05). Further analyses were conducted on subgroups of age, gender, body mass index, baseline medical condition and extra sensitivity analyses, the results are still robust. In conclusion, an elevated LMR was associated with a lower mortality rate in patients with cancers. LMR may serve as a potential inflammatory predictor of cancer mortality prognosis, outperform NLR and PLR, as well as guide clinical treatment.

Keywords

LMR, Mortality, Cancer Prognosis, Inflammation, NHANES

Cite This Paper

Lei Yang, Xiaohe Sun, Shuai Chen, Hua Shao. Lymphocyte-to-Monocyte Ratio: A Simple and Effective Inflammation Marker in Predicting Mortality of Non-Institutionalized Americans with Cancers. Academic Journal of Medicine & Health Sciences (2024), Vol. 5, Issue 5: 71-79. https://doi.org/10.25236/AJMHS.2024.050510.

References

[1] Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71 (1): 7-33. doi: 10.3322/caac.21654.

[2] Greten FR, Grivennikov SI. Inflammation and Cancer: Triggers, Mechanisms, and Consequences. Immunity 2019; 51 (1): 27-41. doi: 10.1016/j.immuni.2019.06.025.

[3] Hernandez-Gea V, Toffanin S, Friedman SL, et al. Role of the microenvironment in the pathogenesis and treatment of hepatocellular carcinoma. Gastroenterology 2013; 144 (3): 512-527. doi: 10.1053/j.gastro.2013.01.002.

[4] Induction of immunosuppressive functions and NF-κB by FLIP in monocytes.[J].Nature Communications, 2018.DOI:10.1038/s41467-018-07654-4.

[5] Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell 2010; 140 (6): 883-899. doi: 10.1016/j.cell.2010.01.025.

[6] Kim NY, Chun D-H, Kim SY, et al. Prognostic Value of Systemic Inflammatory Indices, NLR, PLR, and MPV, for Predicting 1-Year Survival of Patients Undergoing Cytoreductive Surgery with HIPEC. J Clin Med 2019; 8 (5): 589. doi: 10.3390/jcm8050589.

[7] Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013; 11 (1): 55-59. doi: 10.1586/erc.12.159.

[8] Ying H-Q, Deng Q-W, He B-S, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Medical Oncology 2014; 31 (12): 305. doi: 10.1007/s12032-014-0305-0.

[9] Ahn J, Song E, Oh HS, et al. Low Lymphocyte-to-Monocyte Ratios Are Associated with Poor Overall Survival in Anaplastic Thyroid Carcinoma Patients. Thyroid 2019; 29 (6): 824-829. doi: 10.1089/thy.2018.0684.

[10] Matsuki E, Bohn OL, El Jamal S, et al. Lymphocyte-to-Monocyte Ratio May Serve as a Better Prognostic Indicator Than Tumor-associated Macrophages in DLBCL Treated With Rituximab. Appl Immunohistochem Mol Morphol 2019; 27 (8): 572-580. doi: 10.1097/pai.0000000000000645.

[11] Lockhart AC, Rothenberg ML, Berlin JD. Treatment for pancreatic cancer: current therapy and continued progress. Gastroenterology 2005; 128 (6): 1642-1654. doi: 10.1053/j.gastro.2005.03.039.

[12] Jin Y-N, Yao J-J, Zhang F, et al. Is pretreatment Epstein-Barr virus DNA still associated with 6-year survival outcomes in locoregionally advanced nasopharyngeal carcinoma? J Cancer 2017; 8 (6): 976-982. doi: 10.7150/jca.18124.

[13] Dolan RD, Lim J, McSorley ST, et al. The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis. Sci Rep 2017; 7 (1): 16717. doi: 10.1038/s41598-017-16955-5.

[14] Oylumlu M, Oylumlu M, Arik B, et al. Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome. Int J Clin Pract 2021; 75 (5): e13973. doi: 10.1111/ijcp.13973.

[15] Bedel C, Korkut M, Armağan HH. Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? A commentary. Bosn J Basic Med Sci 2021; 21 (4): 501. doi: 10.17305/bjbms.2020.5236.

[16] Russell CD, Parajuli A, Gale HJ, et al. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. J Infect 2019; 78 (5): 339-348. doi: 10.1016/j.jinf.2019.02.006.

[17] Li M, Xie L. Correlation between NLR, PLR, and LMR and Disease Activity, Efficacy Assessment in Rheumatoid Arthritis. Evid Based Complement Alternat Med 2021; 2021 4433141. doi: 10.1155/2021/4433141.

[18] Chong L, Han L, Liu R, et al. Association of Lymphocyte-to-Monocyte Ratio with Poststroke Depression in Patients with Acute Ischemic Stroke. Med Sci Monit 2021; 27 e930076. doi: 10.12659/msm.930076.

[19] Zhang J, Feng G, Zhao Y, et al. Association between lymphocyte-to-monocyte ratio (LMR) and the mortality of HBV-related liver cirrhosis: a retrospective cohort study. BMJ Open 2015; 5 (8): e008033. doi: 10.1136/bmjopen-2015-008033.

[20] Gawiński C, Michalski W, Mróz A, et al. Correlation between Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Tumor-Infiltrating Lymphocytes (TILs) in Left-Sided Colorectal Cancer Patients. Biology (Basel) 2022; 11 (3): doi: 10.3390/biology11030385.

[21] Yamamoto T, Kawada K, Obama K. Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients. Int J Mol Sci 2021; 22 (15): doi: 10.3390/ijms22158002.

[22] Suzuki K, Nishiwaki K, Nagao R, et al. Clinical significance of the lymphocyte-to-monocyte ratio in multiple myeloma patients with negative minimal residual disease: a single-center retrospective analysis. Int J Hematol 2021; 114 (5): 599-607. doi: 10.1007/s12185-021-03201-y.

[23] Deng Y, Li W, Liu X, et al. The combination of platelet count and lymphocyte to monocyte ratio is a prognostic factor in patients with resected breast cancer. Medicine (Baltimore) 2020; 99 (18): e18755. doi: 10.1097/md.0000000000018755.

[24] Pan YC, Jia ZF, Cao DH, et al. Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients. Medicine (Baltimore) 2018; 97 (52): e13896. doi: 10.1097/md.0000000000013896.

[25] Lv X, Han S, Xu B, et al. The value of complete blood count for the prognosis analysis of preoperative esophageal squamous cell carcinoma. BMC Cancer 2021; 21 (1): 1072. doi: 10.1186/s12885-021-08789-2.

[26] Lee A, Lee HJ, Huang HH, et al. Prognostic Significance of Inflammation-associated Blood Cell Markers in Nonmetastatic Clear Cell Renal Cell Carcinoma. Clinical Genitourinary Cancer 2020; 18 (4): 304-313. doi: 10.1016/j.clgc.2019.11.013.

[27] Song X, Zhang H, Yin F, et al. Systemic Inflammatory Markers for Predicting Overall Survival in Patients with Osteosarcoma: A Systematic Review and Meta-Analysis. Mediators Inflamm 2021; 2021 3456629. doi: 10.1155/2021/3456629.

[28] Yapar A, Tokgöz MA, Yapar D, et al. Diagnostic and prognostic role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and lymphocyte/monocyte ratio in patients with osteosarcoma. Jt Dis Relat Surg 2021; 32 (2): 489-496. doi: 10.52312/jdrs.2021.79775.

[29] Liu N, Mao J, Tao P, et al. The relationship between NLR/PLR/LMR levels and survival prognosis in patients with non-small cell lung carcinoma treated with immune checkpoint inhibitors. Medicine (Baltimore) 2022; 101 (3): e28617. doi: 10.1097/md.0000000000028617.

[30] Yoshida T, Kinoshita H, Yoshida K, et al. Prognostic impact of perioperative lymphocyte–monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumor Biology 2016; 37 (8): 10067-10074. doi: 10.1007/s13277-016-4874-8.

[31] Go SI, Kim RB, Song HN, et al. Prognostic significance of the lymphocyte-to-monocyte ratio in patients with small cell lung cancer. Med Oncol 2014; 31 (12): 323. doi: 10.1007/s12032-014-0323-y.