title: Low preoperative lymphocyte to monocyte ratio predicts poor cancer-specific survival in patients with esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Recent studies have shown that the lymphocyte to monocyte ratio (LMR) is a useful predictive factor in various cancers. However, the prognostic value of LMR in patients with esophageal cancer has not been reported yet. The purpose of the current study was to determine the prognostic role of LMR in esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  Three-hundred and forty-eight patients who had undergone esophagectomy for ESCC were included. A receiver operating characteristic curve for survival prediction was plotted to verify the optimum cut-off point for LMR. Kaplan-Meier method was used to calculate the cancer-specific survival (CSS), the difference was assessed by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic factors.
  
  
  RESULTS
  A receiver operating characteristic curve for survival prediction was plotted to verify the optimum cut-off point for LMR, which was 2.93. Patients with LMR ≤2.93 had a significantly worse 5-year CSS than patients with LMR >2.93 (21.2% versus 59.3%, P<0.001). For subgroup analysis, the predictive value of LMR was also significant in patients with T1-2 cancer (P=0.003), T3-4a (P<0.001), and patients with (P=0.044) or without (P<0.001) nodal metastasis. In addition, the predictive value of LMR was also significant stratified by absolute lymphocyte count (P<0.001) and absolute monocyte count (P<0.001). In multivariate analysis, LMR was a significant predictive factor of CSS (P=0.010).
  
  
  CONCLUSIONS
  LMR is still a predictive factor for long-term survival in patients with ESCC. We conclude that 2.93 may be the optimum cut-off point for LMR in predicting survival in ESCC patients.
authors.affiliation: Department of Operating Theatre, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Ji-Feng
authors.initials: JF
authors.lastname: Feng
keywords: cancer-specific survival; esophageal cancer; lymphocyte to monocyte ratio; prognostic factor; squamous cell carcinoma