Medical Oncology

, 31:70 | Cite as

Prognostic impact of circulating monocytes and lymphocyte-to-monocyte ratio on previously untreated metastatic non-small cell lung cancer patients receiving platinum-based doublet

  • Gui-Nan Lin
  • Jie-Wen Peng
  • Jian-jun Xiao
  • Dong-Ying Liu
  • Zhong-Jun XiaEmail author
Original Paper


The link between circulating lymphocyte-to-monocyte ratio (LMR) and newly diagnosed metastatic non-small cell lung cancer (NSCLC) is not fully defined. The study was conducted to evaluate the prognostic impact of LMR on survival outcomes in previously untreated metastatic NSCLC patients receiving platinum-based doublet. Chemotherapy-naive metastatic NSCLC patients undergoing platinum-based doublet were retrospectively enrolled. Clinical features regarding gender, age, Eastern Cooperative Oncology Group (ECOG) performance status, histology, absolute lymphocyte count (ALC), absolute monocyte count (AMC) and LMR were collected to determinate their prognostic impact on progression-free survival (PFS) and overall survival (OS). Up to 370 patients were eligible for the study. By univariate analysis, ECOG performance status, histology, ALC, AMC and LMR were showed to be significantly associated with PFS and OS. In subsequent Cox multivariate analysis, non-squamous cell carcinoma, ALC ≥2.45 × 109/L, AMC <0.45 × 109/L and LMR ≥4.56 were demonstrated to be independently correlated with better PFS. In addition, independent favorable prognostic factors for OS were only limited to LMR ≥4.56 and non-squamous cell carcinoma, whereas ECOG performance status of 2 and AMC ≥0.45 × 109/L remained as independently inferior prognostic indicators for OS. Our findings implicate that circulating AMC and LMR are regarded as independent prognostic factors for PFS and OS in previously untreated metastatic NSCLC patients receiving platinum-based doublet.


Chemotherapy Lung cancer Lymphocyte-to-monocyte ratio Monocyte Prognosis 


Conflict of interest



  1. 1.
    She J, Yang P, Hong Q, Bai C. Lung cancer in China: challenges and interventions. Chest. 2013;143(4):1117–26.PubMedCrossRefGoogle Scholar
  2. 2.
    Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346(2):92–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Kobayashi N, Usui S, Kikuchi S, et al. Preoperative lymphocyte count is an independent prognostic factor in node-negative non-small cell lung cancer. Lung Cancer. 2012;75(2):223–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Zhang J, Huang SH, Li H, et al. Preoperative lymphocyte count is a favorable prognostic factor of disease-free survival in non-small-cell lung cancer. Med Oncol. 2013;30(1):352.PubMedCrossRefGoogle Scholar
  6. 6.
    Pollard JW. Tumor-educated macrophages promote tumor progression and metastasis. Nat Rev Cancer. 2004;4(1):71–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Huang JJ, Li YJ, Xia Y, et al. Prognostic significance of peripheral monocyte count in patients with extranodal natural killer/T-cell lymphoma. BMC Cancer. 2013;13:222.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Li J, Jiang R, Liu WS, et al. A large cohort study reveals the association of elevated peripheral blood lymphocyte-to-monocyte ratio with favorable prognosis in nasopharyngeal carcinoma. PLoS One. 2013;8:e83069.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Lee YY, Choi CH, Sung CO, et al. Prognostic value of pre-treatment circulating monocyte count in patients with cervical cancer: comparison with SCC-Ag level. Gynecol Oncol. 2012;124:92–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Li ZM, Huang JJ, Xia Y, et al. Blood lymphocyte-to-monocyte ratio identifies high-risk patients in diffuse large B-cell lymphoma treated with R-CHOP. PLoS One. 2012;7:e41658.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Koh YW, Kang HJ, Park C, Yoon DH, et al. The ratio of the absolute lymphocyte count to the absolute monocyte count is associated with prognosis in Hodgkin’s lymphoma: correlation with tumor-associated macrophages. Oncologist. 2012;17:871–80.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Stotz M, Pichler M, Absenger G, et al. The preoperative lymphocyte to monocyte ratio predicts clinical outcome in patients with stage III colon cancer. Br J Cancer. 2014;110(2):435–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Pine SR, Mechanic LE, Enewold L, et al. Increased levels of circulating interleukin 6, interleukin 8, C-reactive protein, and risk of lung cancer. J Natl Cancer Inst. 2011;103(14):1112–22.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Shiels MS, Pfeiffer RM, Hildesheim A, et al. A circulating inflammation markers and prospective risk for lung cancer. J Natl Cancer Inst. 2013;105(24):1871–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Blackwell TS, Christman JW. The role of nuclear factor-κB in cytokine gene regulation. Am J Respir Cell Mol Biol. 1997;17:3–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Stathopoulos GT, Sherrill TP, Han W, et al. Host nuclear factor-kappaB activation potentiates lung cancer metastasis. Mol Cancer Res. 2008;6(3):364–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Botta C, Barbieri V, Ciliberto D, et al. Systemic inflammatory status at baseline predicts bevacizumab benefit in advanced non-small cell lung cancer patients. Cancer Biol Ther. 2013;14(6):469–75.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Qian BZ, Li J, Zhang H, et al. CCL2 recruits inflammatory monocytes to facilitate breast-tumor metastasis. Nature. 2011;475(7355):222–5.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Wang R, Zhang J, Chen S, et al. Tumor-associated macrophages provide a suitable microenvironment for non-small lung cancer invasion and progression. Lung Cancer. 2011;74(2):188–96.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen JJ, Lin YC, Yao PL, et al. Tumor-associated macrophages: the double-edged sword in cancer progression. J Clin Oncol. 2005;23(5):953–64.PubMedCrossRefGoogle Scholar
  21. 21.
    Ryder M, Gild M, Hohl TM, et al. Genetic and pharmacological targeting of CSF-1/CSF-1R inhibits tumor-associated macrophages and impairs BRAF-induced thyroid cancer progression. PLoS One. 2013;8(1):e54302.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Pyonteck SM, Akkari L, Schuhmacher AJ, et al. CSF-1R inhibition alters macrophage polarization and blocks glioma progression. Nat Med. 2013;19(10):1264–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Huang JJ, Jiang WQ, Lin TY, et al. Absolute lymphocyte count is a novel prognostic indicator in extranodal natural killer/T-cell lymphoma, nasal type. Ann Oncol. 2011;22(1):149–55.PubMedCrossRefGoogle Scholar
  24. 24.
    Mahmoud SM, Paish EC, Powe DG, et al. Tumor-infiltrating CD8+ lymphocytes predict clinical outcome in breast cancer. J Clin Oncol. 2011;29:1949–55.PubMedCrossRefGoogle Scholar
  25. 25.
    Tang Y, Xu X, Guo S, et al. An increased abundance of tumor-infiltrating regulatory T cells is correlated with the progression and prognosis of pancreatic ductal adenocarcinoma. PLoS One. 2014;9:e91551.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gui-Nan Lin
    • 1
  • Jie-Wen Peng
    • 1
  • Jian-jun Xiao
    • 1
  • Dong-Ying Liu
    • 2
  • Zhong-Jun Xia
    • 3
    • 4
    Email author
  1. 1.Department of Medical OncologyZhongshan Hospital of Sun Yat-sen University, Zhongshan City People’s HospitalZhongshanPeople’s Republic of China
  2. 2.Department of Clinical OncologyJiangmen Hospital of Sun Yat-sen University, Jiangmen City Central HospitalJiangmenPeople’s Republic of China
  3. 3.State Key Laboratory of Oncology in South ChinaGuangzhouPeople’s Republic of China
  4. 4.Department of Hematologic OncologySun Yat-sen University Cancer CenterGuangzhouPeople’s Republic of China

Personalised recommendations