The Lymphocyte-to-Monocyte ratio is a superior predictor of OS in comparison to established biomarkers in CRC patients undergoing curative resection. — ASN Events
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The Lymphocyte-to-Monocyte ratio is a superior predictor of OS in comparison to established biomarkers in CRC patients undergoing curative resection. (#19)

Joseph Chan 1 2 , David Chan 3 , Connie Diakos 1 2 3 , Anthony Gill 2 4 , Alexander Engel 2 4 , Stephen Clarke 1 2 3
  1. Bill Walsh translational cancer research laboratory, Kolling Institute, The University of Sydney, St Leonards, NSW, Australia
  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  3. Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
  4. Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia

Background:  The prognostic significance of systemic inflammatory markers in colorectal cancer (CRC) such as the Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and modified Glasgow prognostic score (mGPS) have been well defined in literature. Commonly utilized genetic markers such as combined BRAF-MMR status have also been found to be prognostic. Recent evidence suggests that the lymphocyte-to-monocyte ratio (LMR) may hold prognostic utility in CRC, however previous studies have been limited by size and scope.

Aims: The study aims to investigate the prognostic value of the LMR in CRC patients undergoing curative resection and to compare it to established biomarkers including the NLR, PLR, mGPS and combined BRAF-MMR status.

Methods: Consecutive patients from the Northern Sydney Local Health District undergoing curative surgical resection for colorectal cancer from January 1998 to December 2012 were collated. Of the 3281 patients identified, 1623 patients with complete pre-operative blood counts, BRAF-MMR IHC and clinicopathologic data were further analysed.  Variables were analysed in univariate and then a multivariate cox regression model using forwards conditional method looking for association with overall survival (OS).

Results: In multivariate analysis of 1623 patients, elevated LMR was associated with better overall survival (OS) (HR 0.565, 95% CI: 0.475-0.672, P<0.001) independent of age (P<0.001), T stage (P<0.001), N stage (P<0.001) and grade (P=0.049). Other biomarkers such as NLR, PLR and combined BRAF-MMR status were not significantly associated with OS. In multivariate subgroup analysis of 389 patients with mGPS, LMR remained the only independently prognostic biomarker (HR 0.620, 95% CI: 0.437-0.880, p=0.007).

Conclusion: The LMR is an independent predictor of OS in CRC patients undergoing curative resection. Furthermore, the LMR appears to be superior to pre-existing established biomarkers.


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