Prognostic Value Of Blood Lymphocyte-to-monocyte Ratio, Platelet-to-lymphocyte Ratio And Neutrophil-to-lymphocyte Ratio In Patients With Malignant Pleural Mesothelioma

Objective:To investigate the prognostic value of lymphocyte / monocyte ratio(LMR),platelet / lymphocyte ratio(PLR)and neutrophil / lymphocyte ratio(NLR)in malignant pleural mesothelioma(MPM)patients.Methods: From January 2000 to September 2016,39 cases of MPM patients with definite pathological diagnosis,treated at the First Affiliated Hospital of Soochow University,were collected to be analyzed.The clinical data of patients were collected through medical record query and telephone follow-up.The data of the variables were analyzed by Fisher exactness method.According to the optimal cut-off of receiver operator characteristic(ROC)curve,LMR,PLR,and NLR were grouped respectively.Kaplan-Meier method and log rank test were used to compare the survival curves of each group.Univariate analysis by Cox regression model was performed to get the factors associated with prognosis of patients.Multivariate analysis was performed by stepwise regression.SPSS22.0 software was used for data processing and analysis.P<0.05 was statistically significant.Result1 The most appropriate cutoff value of LMR,PLR and NLR were 2.73,151,5.07.According to the value,patients were divided into high LMR group(LMR ?2.73,n=23)and low LMR group(LMR<2.73,n=16),high PLR group(PLR ?151,n=29)and low PLR group(PLR<151,n=10),high NLR group(NLR?5.07,n=19)and low NLR group(NLR<5.07,n=20).2 The median survival time of elevated LMR group of patients was 25 months(95%CI,21.32-28.68),the median survival time of low LMR group was 9 months(95%CI,5.11-12.89),the difference was statistically significant(P<0.001).The median survival time of low PLR group of patients was 27 months(95%CI,24.08-29.92),the median survival time of elevated PLR group was 15 months(95%CI,9.73-20.27),the difference was statistically significant(P<0.024).The median survival time of low NLR group of patients was 22 months(95%CI,12.05-31.95),the median survival time of elevated NLR group was 10 months(95%CI,6.58-13.41),the difference was statistically significant(P<0.041).3 Univariate analysis showed that gender(HR,0.388;95%CI,0.170~0.884;P=0.024),tumor stage(HR,4.343;95%CI,1.932-9.762;P<0.001),ECOG PS score(HR,10.905;95%CI,3.820-31.137;P<0.001),monocyte count(HR,0.385;95%CI,0.182-0.814;P=O.013),LMR<2.73(HR,5.410;95%CI,2.567-11.400;P<0.001),PLR>151(HR,2.513;95%CI,1.082-5.837;P=0.032),NLR>5.07(HR,1.993;95%CI,1.007-3.946;P=0.048)were risk factors for the prognosis of MPM.Multivariate analysis showed that stage III/IV(HR,2.973;95%CI,1.152-7.675;P=0.024),PS>1(HR,5.321;95%CI,1.783-15.879;P=0.003),LMR<2.73(HR,4.757;95%CI,1.641-13.793;P=0.004)were independent prognostic factors in MPM patients.Summary:1 PLR and NLR were not independent prognostic factors for patients with MPM.2 The decrease of LMR in peripheral blood suggested poor prognosis of MPM,which was an independent prognostic marker for patients with MPM.LMR had instructional significance for clinic.