Prognostic Significance of Preoperative Lymphocyte-Monocyte Ratio in Patients with Resectable Esophageal Squamous Cell Carcinoma

Background: The interaction between tumor cells and inflammatory cells has not been systematicallyinvestigated in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to evaluatewhether preoperative the lymphocyte-monocyte ratio (LMR), the neutrophil-lymphocyte ratio (NLR), andthe platelet-lymphocyte ratio (PLR) could predict the prognosis of ESCC patients undergoing esophagectomy.Materials and
Methods: Records from 218 patients with histologically diagnosed ESCC who underwent attemptedcurative surgery from January 2007 to December 2008 were retrospectively reviewed. Besides clinicopathologicalprognostic factors, we evaluated the prognostic value of the LMR, the NLR, and the PLR using Kaplan-Meiercurves and Cox regression models.
Results: The median follow-up was 38.6 months (range 3-71 months). Thecut-off values of 2.57 for the LMR, 2.60 for the NLR and 244 for the PLR were chosen as optimal to discriminatebetween survival and death by applying receiver operating curve (ROC) analysis. Kaplan-Meier survivalanalysis of patients with low preoperative LMR demonstrated a significant worse prognosis for DFS (p=0.004)and OS (p=0.002) than those with high preoperative LMR. The high NLR cohort had lower DFS (p=0.004)and OS (p=0.011). Marginally reduced DFS (p=0.068) and lower OS (p=0.039) were found in the high PLRcohort. On multivariate analysis, only preoperative LMR was an independent prognostic factor for both DFS(p=0.009, HR=1.639, 95% CI 1.129-2.381) and OS (p=0.004, HR=1.759, 95% CI 1.201-2.576) in ESCC patients.
Conclusions: Preoperative LMR better predicts cancer survival compared with the cellular components ofsystemic inflammation in patients with ESCC undergoing esophagectomy.