title: The Lymphocyte-to-Monocyte Ratio is a Superior Predictor of Overall Survival in Comparison to Established Biomarkers of Resectable Colorectal Cancer.
abstract: 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.
authors.affiliation: *Bill Walsh Translational Research Laboratories, Kolling Institute of Medical Research, St Leonards, NSW, Australia †Sydney Medical School, University of Sydney, Sydney, NSW, Australia ‡Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia §Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia ¶Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia.
authors.forename: Joseph C Y
authors.initials: JC
authors.lastname: Chan
authors.forename: David L
authors.initials: DL
authors.lastname: Chan
authors.forename: Connie I
authors.initials: CI
authors.lastname: Diakos
authors.forename: Alexander
authors.initials: A
authors.lastname: Engel
authors.forename: Nick
authors.initials: N
authors.lastname: Pavlakis
authors.forename: Anthony
authors.initials: A
authors.lastname: Gill
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Clarke
mesh_terms: D000368:Aged; D001315:Australia; D014408:Biomarkers, Tumor / Q000097:blood*; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007963:Leukocytes, Mononuclear / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor