Prognostic significance of the lymphocyte-to-monocyte ratio in patients with malignant pleural mesothelioma

Our plain-English summary of Prognostic significance of the lymphocyte-to-monocyte ratio in patients with malignant pleural mesothelioma, by T. Yamagishi, N. Fujimoto, H. Nishi, et al (Lung Cancer, 2015).

The study

• Authors: T. Yamagishi, N. Fujimoto, H. Nishi, Y. Miyamoto, N. Hara, M. Asano, Y. Fuchimoto, S. Wada, K. Kitamura, S. Ozaki, T. Kishimoto
• Journal: Lung Cancer
• Published: 2015;90(1):111-7
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Chronic inflammation plays a key role in the pathogenesis of malignant pleural mesothelioma (MPM) as a result of asbestos exposure. Several inflammation-based prognostic scores including the lymphocyte-to-monocyte ratio (LMR), Glasgow Prognostic Score (GPS), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) reportedly predict survival in many malignancies, while the role of LMR in MPM remains unclear. The aim of this study was to evaluate the clinical value of LMR and to compare the prognostic value of these inflammation-based scores in predicting overall survival (OS) in MPM.

Materials And Methods: One hundred and fifty patients with histologically proven MPM were included in this retrospective study. Kaplan-Meier curves and multivariate Cox-regression analyses were calculated for OS. The area under the receiver operating characteristics curve (AUC) was calculated to compare the discriminatory ability of each scoring system.

Results: An elevated LMR was significantly associated with prolonged OS. Patients with LMR <2.74 had significantly poor survival compared with LMR ≥2.74 (median, 5.0 versus 14.0 months; p=0.000). The LMR consistently had a higher AUC value at 6 months (0.722), 12 months (0.712), and 24 months (0.670), compared with other scores. Multivariate analysis showed that the LMR was independently associated with OS.

Conclusions: The LMR is an independent prognostic marker for OS in patients with MPM and is superior to other inflammation-based prognostic scores with respect to prognostic ability.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective study from Okayama Rosai Hospital, Japan, examined 150 consecutive patients with malignant pleural mesothelioma diagnosed between July 1993 and October 2014. Most were men (93.3%), and the median age was 70. The authors used blood samples taken at diagnosis to calculate the lymphocyte-to-monocyte ratio (LMR), a ratio of two types of blood cell. They compared it with other inflammation-based scores (NLR, PLR, GPS and mGPS) for predicting how long patients lived. The article did not report measuring or analysing asbestos exposure. Median overall survival was 5.0 months (95% CI 4.0–10.0) for patients with an LMR below 2.74 and 14.0 months (95% CI 13.0–23.0) for those with an LMR of 2.74 or higher. After taking other factors into account, a low LMR remained linked to shorter survival (hazard ratio 2.34; 95% CI 1.58–3.47). The LMR also predicted survival better than the other scores at 6, 12 and 24 months. The authors concluded that the LMR is an independent marker of prognosis in these patients. They noted that the study was retrospective and single-centre, and that it did not assess conditions such as infection or diabetes that can affect blood counts.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-centre study of patients' medical records (prognostic marker study)
• Who was studied: 150 consecutive patients with histologically proven malignant pleural mesothelioma, diagnosed July 1993 to October 2014 at Okayama Rosai Hospital, Japan; median age 70 (range 38–92); 93.3% male
• Exposure: The factor studied was not asbestos exposure. The article does not report measuring or analysing asbestos exposure. The factor studied was the lymphocyte-to-monocyte ratio (lymphocyte count divided by monocyte count), along with other inflammation-based scores (NLR, PLR, GPS, mGPS). All were taken from blood samples at diagnosis.
• Main results:
  • The best LMR cut-off for overall survival was 2.74. Of the 150 patients, 41 (27.3%) had an LMR below 2.74 and 109 (72.7%) had an LMR of 2.74 or higher.
  • Median overall survival was 5.0 months (95% CI 4.0–10.0) in patients with LMR below 2.74 and 14.0 months (95% CI 13.0–23.0) in patients with LMR of 2.74 or higher.
  • In multivariate analysis, LMR below 2.74 was an independent prognostic factor for overall survival (hazard ratio 2.34; 95% CI 1.58–3.47). The other independent factors were performance status above 1, non-epithelioid subtype, stage III/IV and no surgery.
  • The LMR had a higher area under the ROC curve than the other inflammation-based scores at 6, 12 and 24 months: 0.772 at 6 months as printed in the results section (0.722 in the abstract), 0.712 at 12 months and 0.670 at 24 months.
  • In subgroup (univariate) analyses, a low LMR was significantly associated with worse survival in patients with the epithelioid subtype (HR 2.76; 95% CI 1.61–4.71) and in patients with the non-epithelioid subtype (HR 3.38; 95% CI 1.67–6.87). It was also significant in stage I/II and stage III/IV patients, and in patients with and without surgery.
• The authors' conclusion: The authors concluded that the LMR is an independent prognostic marker for overall survival in patients with malignant pleural mesothelioma, and that it is better at predicting prognosis than the other inflammation-based scores.
• Limitations the authors state:
  • The study was retrospective and from a single centre.
  • The study did not assess possible confounding conditions that can affect lymphocyte and monocyte counts. Examples are infection, ischemia, acute coronary syndrome, metabolic syndrome, diabetes, and kidney or liver dysfunction.
  • The authors stated that a large prospective validation study is needed to confirm the results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chronic Inflammation, Asbestos Exposure, Inflammation, Overall Survival, Kaplan-Meier Curve, Multivariate Analysis.

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• Comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma' — S.C. Kao, N. van Zandwijk, et al. (2014)
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