Predictive value of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy

Abstract

Background and objectives: The survival rate of patients with advanced oesophageal cancer is very low and can vary significantly, even among patients with the same TNM stage. It is important to look for indicators that are economical and readily available to predict overall survival. The aim of this study was to determine whether lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) could be potential predictors of survival in patients with advanced oesophageal squamous cell carcinoma (ESCC) undergoing concurrent chemoradiotherapy.

Methods: Differences in survival among 204 patients with advanced oesophageal cancer who underwent concurrent chemoradiotherapy were collected and analysed. Univariate and multivariate COX regression analyses were used to investigate the association between blood inflammatory markers and patient survival before treatment.

Results: Univariate COX regression analyses showed that a history of alcohol use, neutrophil count, LMR, NLR, tumour length, and N stage were significantly associated with the survival of tumour patients receiving concurrent chemoradiotherapy. Multivariate COX regression analysis showed that NLR and LMR were predictors of outcome in tumour patients receiving chemoradiotherapy. According to receiver operating characteristic (ROC) curve analysis, the AUC of LMR and NLR was 0.734 and 0.749, and the best cutoff point for LMR and NLR was 3.03 and 2.64, respectively.

Conclusions: LMR and NLR can be used to predict the survival of patients with advanced oesophageal cancer receiving concurrent chemoradiotherapy, thereby providing clinicians with suggestions for further treatment options.

Keywords: Blood inflammatory markers; Concurrent chemoradiotherapy; Oesophageal cancer; Overall survival.

Fig. 1

Receiver operating characteristic (ROC) curve plotted to determine the value of a statistically significant variable in the COX regression model for NLR (a) and LMR (b). According to ROC analysis, the area under the curve of NLR and LMR was 0.749 and 0.734, respectively, and the optimal cutoff point was 2.64 and 3.03, respectively

Fig. 2

Kaplan-Meier survival curves for patients with advanced oesophageal cancer in different NLR groups. The blue curve represents the overall survival of patients with an NLR less than 2.64, while the green curve represents the overall survival of patients with an NLR greater than or equal to 2.64. The mean survival time of patients in the low NLR group was 19.8 months, and the mean survival time of patients in the high NLR group was 10.3 months, with a p < 0.05, indicating a significant difference between the two groups

Fig. 3

Kaplan-Meier survival curves for patients with advanced oesophageal cancer in different LMR groups. The blue curve represents the overall survival of patients with an LMR less than 3.03, while the green curve represents the overall survival of patients with an LMR greater than or equal to 3.03. The mean survival time of patients in the group with an LMR less than 3.03 was 8.3 months, while that of patients in the group with an LMR greater than or equal to 3.03 was 20.2 months, with a p value less than 0.05, indicating a significant difference between the two groups