title: Lymphocyte-to-monocyte ratio can predict mortality in pancreatic adenocarcinoma.
abstract: OBJECTIVE
  To determine if the lymphocyte-to-monocyte ratio (LMR) could be helpful in predicting survival in patients with pancreatic adenocarcinoma.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients diagnosed with pancreatic adenocarcinoma in the VA North Texas Healthcare System from January 2005 to December 2010. The LMR was calculated from peripheral blood cell counts obtained at the time of diagnosis of pancreatic cancer by dividing the absolute lymphocyte count by the absolute monocyte count. A Univariable Cox regression analysis was performed using these data, and hazard ratios (HR) and 95%CI were calculated. The median LMR (2.05) was used to dichotomize patients into high-LMR and low-LMR groups and the log rank test was used to compare survival between the two groups.
  
  
  RESULTS
  We identified 97 patients with pancreatic adenocarcinoma (all men, 66% white, 30% African-American). The mean age and weight at diagnosis were 66.0 ± 0.9 (SEM) years and 80.4 ± 1.7 kg respectively. Mean absolute lymphocyte and monocyte values were 1.50 ± 0.07 K/μL and 0.74 ± 0.03 K/μL respectively. Mean, median and range of LMR was 2.36, 2.05 and 0.4-12 respectively. In the univariable Cox regression analysis, we found that an increased LMR was a significant indicator of improved overall survival in patients with pancreatic adenocarcinoma (HR = 0.83; 95%CI: 0.70-0.98;P= 0.027). Kaplan-Meier analysis revealed an overall median survival of 128 d (95%CI: 80-162 d). The median survival of patients in the high-LMR (> 2.05) group was significantly greater than the low-LMR group (≤ 2.05) (194 dvs93 d;P= 0.03), validating a significant survival advantage in patients with a high LMR.
  
  
  CONCLUSIONS
  The LMR at diagnosis is a significant predictor for survival and can provide useful prognostic information in the management of patients with pancreatic adenocarcinoma.
authors.affiliation: Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
authors.forename: Gurshawn
authors.initials: G
authors.lastname: Singh
authors.affiliation: Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
authors.forename: Ammar
authors.initials: A
authors.lastname: Nassri
authors.affiliation: Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
authors.forename: David
authors.initials: D
authors.lastname: Kim
authors.affiliation: Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ramzan
keywords: Biomarker; Lymphocyte-to-monocyte ratio; Mortality; Pancreatic adenocarcinoma; Prognosis