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Lymphocyte to monocyte ratio is associated with response to first-line platinum-based chemotherapy and prognosis of early-stage non-small cell lung cancer patients

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Tumor Biology

Abstract

Lymphocyte to monocyte ratio (LMR) has shown prognostic value in different types of cancer. This study assessed the prognostic performance of LMR in early-stage non-small cell lung cancer (NSCLC) patients and investigated the influence of LMR on the treatment response in patients receiving first-line platinum-based chemotherapy. Four hundred eighty-eight NSCLC patients and 500 healthy donors were enrolled in this study. The cutoff value for LMR was chosen by receiver operating characteristic curve analysis. The prognostic significance of markers was assessed by univariate and multivariate Cox regression models. The median overall survival was 43 months, and the median progression-free survival was 38 months. LMR was associated with disease status and the treatment response of first-line platinum-based chemotherapy. Multivariate analysis showed that LMR was an independent prognostic factor for both overall survival (hazard ratio = 1.53, 95 % confidence interval = 1.09–2.14, P = 0.015) and progression-free survival (hazard ratio = 1.20, 95 % confidence interval = 1.02–1.67, P = 0.028). Furthermore, integration of LMR into a prognostic model including TNM stage, tumor status, chemotherapy, and histological type generated a nomogram, which predicted accurately overall survival for NSCLC patients. Decreased LMR may be a potential biomarker of disease status, worse response to first-line platinum-based chemotherapy, and worse survival for NSCLC patients. A prospective study is warranted for further validation of our findings.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. doi:10.3322/caac.20107.

    Article  PubMed  Google Scholar 

  2. Casanovas O. Cancer: limitations of therapies exposed. Nature. 2012;484(7392):44–6. doi:10.1038/484044a.

    Article  CAS  PubMed  Google Scholar 

  3. Tanner NT, Sherman CA, Silvestri GA. Biomarkers in the selection of maintenance therapy in non-small cell lung cancer. Transl Lung Cancer Res. 2012;1(2):96–8. doi:10.3978/j.issn.2218-6751.2012.03.02.

    PubMed  PubMed Central  Google Scholar 

  4. Hwang JA, Song JS, Yu DY, Kim HR, Park HJ, Park YS, et al. Peroxiredoxin 4 as an independent prognostic marker for survival in patients with early-stage lung squamous cell carcinoma. Int J Clin Exp Pathol. 2015;8(6):6627–35.

    PubMed  PubMed Central  Google Scholar 

  5. Dotsch MM, Kloten V, Schlensog M, Heide T, Braunschweig T, Veeck J, et al. Low expression of ITIH5 in adenocarcinoma of the lung is associated with unfavorable patients’ outcome. Epigenetics. 2015. doi:10.1080/15592294.2015.1078049.

    PubMed  PubMed Central  Google Scholar 

  6. Donnem T, Bremnes RM, Busund LT, Andersen S, Pezzella F. Gene expression assays as prognostic and predictive markers in early stage non-small cell lung cancer. J Thorac Dis. 2012;4(2):212–3. doi:10.3978/j.issn.2072-1439.2012.03.02.

    PubMed  PubMed Central  Google Scholar 

  7. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74. doi:10.1016/j.cell.2011.02.013.

    Article  CAS  PubMed  Google Scholar 

  8. Kim DK, Oh SY, Kwon HC, Lee S, Kwon KA, Kim BG, et al. Clinical significances of preoperative serum interleukin-6 and C-reactive protein level in operable gastric cancer. BMC Cancer. 2009;9:155. doi:10.1186/1471-2407-9-155.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16(3):614–22. doi:10.1245/s10434-008-0267-6.

    Article  PubMed  Google Scholar 

  10. Deng Q, He B, Liu X, Yue J, Ying H, Pan Y, et al. Prognostic value of pre-operative inflammatory response biomarkers in gastric cancer patients and the construction of a predictive model. J Transl Med. 2015;13:66. doi:10.1186/s12967-015-0409-0.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kumagai S, Marumo S, Shoji T, Sakuramoto M, Hirai T, Nishimura T, et al. Prognostic impact of preoperative monocyte counts in patients with resected lung adenocarcinoma. Lung Cancer. 2014;85(3):457–64. doi:10.1016/j.lungcan.2014.06.015.

    Article  PubMed  Google Scholar 

  12. Ozawa T, Ishihara S, Kawai K, Kazama S, Yamaguchi H, Sunami E, et al. Impact of a lymphocyte to monocyte ratio in stage IV colorectal cancer. J Surg Res. 2015. doi:10.1016/j.jss.2015.06.014.

    PubMed  Google Scholar 

  13. Chang Y, An H, Xu L, Zhu Y, Yang Y, Lin Z, et al. Systemic inflammation score predicts postoperative prognosis of patients with clear-cell renal cell carcinoma. Br J Cancer. 2015;113(4):626–33. doi:10.1038/bjc.2015.241.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cannon NA, Meyer J, Iyengar P, Ahn C, Westover KD, Choy H, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. J Thorac Oncol. 2015;10(2):280–5. doi:10.1097/JTO.0000000000000399.

    Article  CAS  PubMed  Google Scholar 

  15. Botta C, Barbieri V, Ciliberto D, Rossi A, Rocco D, Addeo R, 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. doi:10.4161/cbt.24425.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47. doi:10.1016/j.ejca.2008.10.026.

    Article  CAS  PubMed  Google Scholar 

  17. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44. doi:10.1038/nature07205.

    Article  CAS  PubMed  Google Scholar 

  18. King PT. Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer. Clin Transl Med. 2015;4(1):68. doi:10.1186/s40169-015-0068-z.

    Article  PubMed  Google Scholar 

  19. Germano G, Allavena P, Mantovani A. Cytokines as a key component of cancer-related inflammation. Cytokine. 2008;43(3):374–9. doi:10.1016/j.cyto.2008.07.014.

    Article  CAS  PubMed  Google Scholar 

  20. Dunn GP, Bruce AT, Ikeda H, Old LJ, Schreiber RD. Cancer immunoediting: from immunosurveillance to tumor escape. Nat Immunol. 2002;3(11):991–8. doi:10.1038/ni1102-991.

    Article  CAS  PubMed  Google Scholar 

  21. Siveen KS, Kuttan G. Role of macrophages in tumour progression. Immunol Lett. 2009;123(2):97–102. doi:10.1016/j.imlet.2009.02.011.

    Article  CAS  PubMed  Google Scholar 

  22. Heusinkveld M, van der Burg SH. Identification and manipulation of tumor associated macrophages in human cancers. J Transl Med. 2011;9:216. doi:10.1186/1479-5876-9-216.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Gordon S, Martinez FO. Alternative activation of macrophages: mechanism and functions. Immunity. 2010;32(5):593–604. doi:10.1016/j.immuni.2010.05.007.

    Article  CAS  PubMed  Google Scholar 

  24. Heusinkveld M, de Vos van Steenwijk PJ, Goedemans R, Ramwadhdoebe TH, Gorter A, Welters MJ, et al. M2 macrophages induced by prostaglandin E2 and IL-6 from cervical carcinoma are switched to activated M1 macrophages by CD4+ Th1 cells. J Immunol. 2011;187(3):1157–65. doi:10.4049/jimmunol.1100889.

    Article  CAS  PubMed  Google Scholar 

  25. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7. doi:10.1038/nature01322.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Zhang J, Huang SH, Li H, Li Y, Chen XL, Zhang WQ, 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. doi:10.1007/s12032-012-0352-3.

    Article  PubMed  Google Scholar 

  27. Go SI, Kim RB, Song HN, Kang MH, Lee US, Choi HJ, et al. Prognostic significance of the lymphocyte-to-monocyte ratio in patients with small cell lung cancer. Med Oncol. 2014;31(12):323. doi:10.1007/s12032-014-0323-y.

    Article  PubMed  Google Scholar 

  28. Hu P, Shen H, Wang G, Zhang P, Liu Q, Du J. Prognostic significance of systemic inflammation-based lymphocyte-monocyte ratio in patients with lung cancer: based on a large cohort study. PLoS One. 2014;9(9), e108062. doi:10.1371/journal.pone.0108062.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lin GN, Peng JW, Xiao JJ, Liu DY, Xia ZJ. Prognostic impact of circulating monocytes and lymphocyte-to-monocyte ratio on previously untreated metastatic non-small cell lung cancer patients receiving platinum-based doublet. Med Oncol. 2014;31(7):70. doi:10.1007/s12032-014-0070-0.

    Article  PubMed  Google Scholar 

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Author contributions

Conceived and designed the experiments: JT and YJS

Performed the experiments: YJS, LXW, YQH, ZHL, QT, and XZF

Analyzed the data: YJS and LXW

Contributed reagents/materials/analysis tools: LXW and YQH

Wrote the manuscript: YJS and JT

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Authors and Affiliations

  1. Department of Respiratory Medicine, Huai’an First People’s Hospital, Nanjing Medical University, Huai’an, 223300, Jiangsu, China

    Ying-Jian Song, Li-Xin Wang & Yong-Qing Hong

  2. Department of Gerontology, Huai’an First People’s Hospital, Nanjing Medical University, 6 Beijing West Road, Huai’an, 223300, Jiangsu, China

    Zheng-Hong Lu, Qiang Tong, Xiao-Zheng Fang & Juan Tan

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  1. Ying-Jian Song
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  2. Li-Xin Wang
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Correspondence to Juan Tan.

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Song, YJ., Wang, LX., Hong, YQ. et al. Lymphocyte to monocyte ratio is associated with response to first-line platinum-based chemotherapy and prognosis of early-stage non-small cell lung cancer patients. Tumor Biol. 37, 5285–5293 (2016). https://doi.org/10.1007/s13277-015-4397-8

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  • DOI: https://doi.org/10.1007/s13277-015-4397-8

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