title: Decreased pretreatment lymphocyte/monocyte ratio is associated with poor prognosis in stage Ib1-IIa cervical cancer patients who undergo radical surgery.
abstract: BACKGROUND
  Recently, pretreatment monocyte counts and the lymphocyte/monocyte ratio (LMR) have been proven to be significantly associated with the clinical outcomes of several types of cancer. In this study, we analyzed the prognostic significance of the LMR in stage Ib1-IIa cervical cancer patients who underwent a radical operation.
  
  
  METHODS
  A total of 485 patients with stage Ib1-IIa cervical cancer were included in this retrospective study. We evaluated the prognostic values of the absolute lymphocyte count, absolute monocyte count, and LMR by applying receiver operating characteristic curves. Kaplan-Meier curves and multivariate Cox proportional analyses were used to determine the recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  The area under the curve was 0.640 for the RFS and 0.647 for the OS using the LMR. In the univariate analysis, an elevated preoperative LMR was significantly associated with an increased RFS (hazard ratio [HR], 0.373; 95% confidence interval [CI]: 0.247-0.563; P<0.001), and this result remained significant in the multivariate analysis (HR, 0.439; 95% CI: 0.279-0.693; P<0.001). In the univariate analysis, an elevated LMR was also significantly associated with an increased OS (HR, 0.381; 95% CI: 0.233-0.622; P<0.001), and the significance persisted in the multivariate analysis (HR, 0.417; 95% CI: 0.244-0.714; P=0.001).
  
  
  CONCLUSIONS
  A decreased pretreatment LMR is associated with a poor prognosis in stage Ib1-IIa cervical cancer patients who undergo a radical operation. A prospective study is warranted for further validation of our findings.
authors.affiliation: Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People's Republic of China ; Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Radiology, Provincial Hospital Affiliated with Shandong University, Jinan, People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China.
authors.forename: Xiu-Gui
authors.initials: XG
authors.lastname: Sheng
authors.affiliation: Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
authors.forename: Shi-Qian
authors.initials: SQ
authors.lastname: Zhang
keywords: biomarker; cervical cancer; inflammation; lymphocyte/monocyte ratio; tumor microenvironment