title: Preoperative lymphocyte-to-monocyte ratio predicts clinical outcome in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder: a retrospective analysis.
abstract: BACKGROUND
  Inflammation is a critical component of tumorigenesis, and many cancers arise from sites of infection, chronic irritation, and inflammation. Inflammatory cytokines triggered by tumors alter hematologic components, including neutrophil, lymphocyte, and monocyte counts. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios have been shown to be valuable prognostic markers in various types of cancers, including bladder cancer. Risk stratification based on clinicopathologic data is insufficient to support treatment-related choices in patients with bladder cancer. Novel prognostic markers are therefore needed. An elevated pretreatment lymphocyte-to-monocyte ratio (LMR) is reportedly associated with improved overall survival (OS) and a longer time to treatment recurrence (TTR) in some types of cancers. However, these data are lacking in patients with bladder cancer. The aim of the present study was to investigate the effect of the preoperative LMR on OS and TTR in a cohort of patients with bladder cancer.
  
  
  METHODS
  Sixty-eight patients with transitional cell carcinoma of the bladder were included in this retrospective analysis. The associations between a high and low LMR with OS and TTR were analyzed using Kaplan-Meier curves and compared by the log-rank test.
  
  
  RESULTS
  In our study cohort, an elevated preoperative LMR was significantly associated with an increased TTR (P = 0.001) and OS (P = 0.020). Patients with an LMR of ≤2.87 showed a median TTR of 2.0 years (95% CI, 0.27-3.73), whereas patients with an LMR of >2.87 had a median TTR of 11.1 years (95% CI, 2.31-19.88) (P = 0.001). Patients with an LMR of ≤2.81 showed a median OS of 2.7 years (95% CI, 0.63-4.70), whereas patients with an LMR of >2.81 had a median OS of 6.0 years (95% CI, 3.60-8.40) (P = 0.020). The clinical stage at diagnosis was the only clinicopathologic feature associated with the LMR, while tumor invasion depth showed borderline significance.
  
  
  CONCLUSIONS
  The LMR is an easily measured and inexpensive prognostic marker that was significantly correlated with OS and TTR in the present retrospective analysis. However, because of the small sample size in this study, larger multicenter, prospective studies are needed.
authors.affiliation: Departments of Hematology-Oncology, Riad El Solh, Beirut, Lebanon. st29@aub.edu.lb.
authors.forename: Sally
authors.initials: S
authors.lastname: Temraz
authors.forename: Deborah
authors.initials: D
authors.lastname: Mukherji
authors.forename: Zein Al Abideen
authors.initials: ZA
authors.lastname: Farhat
authors.forename: Rami
authors.initials: R
authors.lastname: Nasr
authors.forename: Maya
authors.initials: M
authors.lastname: Charafeddine
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shahait
authors.forename: Mohammad Rachad
authors.initials: MR
authors.lastname: Wehbe
authors.forename: Rami Abou
authors.initials: RA
authors.lastname: Ghaida
authors.forename: Ibrahim Abu
authors.initials: IA
authors.lastname: Gheida
authors.forename: Ali
authors.initials: A
authors.lastname: Shamseddine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000276:immunology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D009364:Neoplasm Recurrence, Local; D057234:Preoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000276:immunology* / Q000601:surgery*