title: The lymphocyte-monocyte ratio predicts tumor response and survival in patients with locally advanced esophageal cancer who received definitive chemoradiotherapy.
abstract: BACKGROUND
  The lymphocyte-monocyte ratio (LMR), a simple biomarker that can reflect the antitumor immune response of the host, has been associated with patient prognosis in several solid tumors. The aim of this study was to evaluate whether LMR can predict clinical tumor response and prognosis in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who received definitive chemoradiotherapy (CRT).
  
  
  METHODS
  A total of 162 advanced ESCC patients treated at our institution between January 2012 and December 2013 were retrospectively recruited for analysis. Patients were treated with a platinum-based bimodal cytotoxic drug chemotherapy and concurrent radiation therapy. The LMR was calculated from blood counts in samples collected prior to treatment initiation. The predictive value of LMR for clinical tumor response and prognosis was examined.
  
  
  RESULTS
  The LMR before CRT was significantly higher in 48 patients who achieved clinical complete response (CR) compared to that in patients who did not achieve clinical CR (4.89±1.17 vs 3.87±1.29,P<0.001). Compared to their matched counterparts, patients in the high LMR group (LMR >4.02) showed a good clinical tumor response (P<0.05). A significant independent association between a high pretreatment LMR and better outcomes was identified in a multivariate analysis for progression-free survival (PFS; hazard ratio [HR]=2.17;P<0.001) and overall survival (OS; HR=2.02;P=0.002).
  
  
  CONCLUSIONS
  In ESCC patients, a high LMR before treatment, which indicates a robust host immune system, is associated with both a good clinical tumor response after definitive CRT and favorable prognosis.
authors.affiliation: School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Minghuan
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Fen
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Yingming
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Fang
authors.initials: F
authors.lastname: Shi
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, People's Republic of China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
keywords: definitive chemoradiotherapy; esophageal squamous cell carcinoma; lymphocyte–monocyte ratio; prognosis; tumor response