J Cancer 2020; 11(17):5078-5087. doi:10.7150/jca.44440

Research Paper

Prognostic significance of combined Lymphocyte-monocyte Ratio and Tumor-associated Macrophages in Gastric Cancer Patients after Radical Resection

Bin-bin Xu1,2,3#, Yu Xu4#, Jun Lu1,2,3#, Yuan Wu4, Jia-bin Wang1,2,3, Jian-xian Lin1,2,3, Jian-wei Xie1,2,3, Ping Li1,2,3, Chao-hui Zheng1,2,3, Ai-min Huang4, Chang-ming Huang1,2,3✉

1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
4. Department of Pathology, the School of Basic Medical Sciences, Fujian Medical University.
#Equal contributors.

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Citation:
Xu Bb, Xu Y, Lu J, Wu Y, Wang Jb, Lin Jx, Xie Jw, Li P, Zheng Ch, Huang Am, Huang Cm. Prognostic significance of combined Lymphocyte-monocyte Ratio and Tumor-associated Macrophages in Gastric Cancer Patients after Radical Resection. J Cancer 2020; 11(17):5078-5087. doi:10.7150/jca.44440. Available from http://www.jcancer.org/v11p5078.htm

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Abstract

Background: Immune function is recognized as an important prognostic indicator in gastric cancer (GC). The relationship between the lymphocyte-monocyte ratio (LMR) and tumor-associated macrophage (TAM) has received far less attention.

Methods: A total of 401 patients from a prospective trial (NCT02327481) were enrolled in this study. The relationships between the LMR, TAM, and clinicopathologic variables were analyzed using a Kaplan-Meier log-rank survival analysis, and multivariate Cox regression models were used to identify associations with recurrence-free survival (RFS) and overall survival (OS). The discriminatory power of the prognostic models for both RFS and OS were compared. The decision curve analysis was performed to compare the clinical utility of the prognostic models.

Results: High LMR was observed in 81.5% of the 401 GC patients, and high TAM infiltration was observed in 45.9% of the patients. In a multivariate Cox analysis of all patients, LMR and TAM were both independent prognostic factors for RFS and OS. Patients with high TAM expression had similar mean LMR levels than patients with low TAM expression. Moreover, LMR appeared to lose its prognostic significance in patients with high TAM expression levels. Finally, the model that included the TAM had better predictive capability and clinical utility for both RFS and OS.

Conclusions: Although LMR and TAM are both independent predictors of RFS and OS in resectable GC patients, LMR seem to attenuate its prognostic significance in patients with high TAM expression. This information may be helpful in the clinical management of patients with GC. Further external studies are warranted to confirm this hypothesis.

Keywords: gastric cancer, lymphocyte-monocyte ratio, tumor-associated macrophage, recurrence, prognosis