Identification of the prognostic value of lymphocyte-to-monocyte ratio in patients with HBV-associated advanced hepatocellular carcinoma

Abstract

The inflammatory microenvironment serves an important function in the progression of hepatocellular carcinoma (HCC). Peripheral blood lymphocyte-to-monocyte ratio (LMR), as a novel inflammatory biomarker combining an estimate of host immune homeostasis with the tumor microenvironment, has been identified to be a predictor of clinical outcomes in a number of malignancies. The present study aimed at investigating the prognostic value of LMR in patients with hepatitis B virus (HBV)-associated advanced HCC. A total of 174 patients with HBV-associated advanced HCC, without fever or signs of infections, were analyzed. Clinicopathological parameters, including LMR, were evaluated to identify predictors of overall survival time. Univariate and multivariate analysis was performed using Cox's proportional hazards model. A threshold value was determined using a time-dependent receiver operating characteristic curve. Univariate and multivariate analysis identified LMR as an independent prognostic factor in overall survival (OS) time in patients with HBV-associated advanced HCC (P<0.05). The threshold value of LMR was 2.22. All patients were divided into either a low LMR group (≤2.22) or a high LMR group (>2.22). The OS time of the high LMR group was significantly longer compared with the low LMR group (P<0.001). Patients in the high LMR group exhibited a significantly increased 3-month and 6-month OS rate, compared with that of the patients within the low LMR group (P<0.001). An increased level of LMR was significantly associated with the presence of metastasis, ascites and increased tumor size (P<0.01). LMR is an independent prognostic factor of HBV-associated advanced HCC patients and an increased baseline LMR level indicates an improved prognosis.

Keywords: advanced hepatocellular carcinoma; chronic hepatitis B virus infection; inflammation; lymphocyte-to-monocyte ratio; prognosis.

Figure 1.

ROC curve assessing the threshold value of LMR for survival analysis in patients. The optimal threshold value of LMR was 2.22, determined using ROC curves, and the area under curve was 0.686 (95% confidence interval, 0.611–0.754; P<0.001) with a sensitivity and specificity of 63.1 and 69.0%, respectively. ROC, receiver operating characteristic; LMR, lymphocyte-to-monocyte ratio.

Figure 2.

Overall survival curves of 174 patients with hepatitis B virus-associated advanced hepatocellular carcinoma. Kaplan-Meier estimator survival curves demonstrated that patients with LMR ≤2.22 had decreased overall survival rates, compared with those with LMR >2.22 (P<0.001, log-rank). LMR, lymphocyte-to-monocyte ratio.