The Lymphocyte-monocyte Ratio (LMR) Predicts Tumor Response And Survival In Patients With Locally Advanced Esophageal Cancer Who Received Definitive Chemoradiotherapy

Objectives: The aim of this study was to evaluate whether lymphocyte-monocyte ratio(LMR)could predict clinical tumor response and prognosis in patients with locally advanced esophageal squamous cell carcinoma(ESCC)who received definitive chemoradiotherapy(CRT).Patients and Methods: A total of 162 advanced ESCC patients at Shandong Cancer Hospital and Institute between January 2012 and December 2013 were retrospectively recruited for analysis.The patients were divided into low absolute lymphocyte count(ALC)(≤1.65×109/L,n=84)group and high ALC group(>1.65×109/L,n=78),low absolute monocyte count(AMC)group(≤0.48×109/L,n=84)and high AMC group(>0.48×109/L,n=78),low LMR(≤4.02,n=81)group and high LMR group(>4.02,n=81),according to median of ALC,AMC and LMR.Assessed clinicopathological parameters between high and low groups and examined the correlation with clinical tumor response and prognosis.Results: Compared to their matched counterparts,patients in the high ALC group(p=0.040)and the high LMR group(p<0.001)showed a good clinical tumor response,but there was no significant differences between high and low AMC groups(p=0.087).The ALC(2.00±0.84 vs.1.69±0.58,p=0.018)and LMR(4.89±1.17 vs.3.87±1.29,p<0.001)before CRT was significantly higher in patients who achieved complete response(CR)compared to that in patients who did not achieve CR,but there was no significant differences of AMC between CR group and non-CR group(p=0.087).Multivariate regression analysis indicated that only an elevated LMR was a significant prognostic factor of a good clinical tumor response(p=0.008).In the univariate analysis,clinical T stage status、clinical tumor stage、clinical tumor response、ALC and LMR were significantly associated with progression free survival(PFS)and overall survival(OS).In the multivariate analysis,we found that clinical T stage status(p=0.043,HR=0.65;95%CI: 0.43-1.00)、clinical tumor response(p=0.006,HR=0.52;95%CI: 0.33-0.83)、ALC(p=0.048,HR=1.50;95%CI: 1.00-2.22)、LMR(p<0.001,HR=1.94;95%CI: 1.29-2.91)were independent factors that associated with PFS in ESCC patients who received definitive CRT.Clinical tumor response(p=0.027,HR=0.55;95%CI: 0.33-0.93)and LMR(p=0.008,HR=1.86;95%CI: 1.17-2.95)were independent factors that associated with OS in ESCC patients who received definitive CRT.Conclusions: 1.Pretreatment absolute lymphocyte count in peripheral blood remained as independent prognostic indicators of PFS for patients with esophageal squamous cell carcinoma who received definitive chemoradiotherapy.2.Pretreatment lymphocyte-monocyte ratio in peripheral blood remained as independent predictive factor associated with clinical tumor response and prognosis for patients with esophageal squamous cell carcinoma who received definitive chemoradiotherapy.