Reproducibility of pretreatment lymphocyte-to-monocyte ratio (LMR) in rectal cancer.

Abstract

715 Background: Lymphocyte-to-monocyte ratio (LMR) is a strong prognostic factor in many cancers. Recently, in Polish-2 study it was demonstrated to have a predictive value for hypofractionated neoadjuvant radiotherapy in rectal cancer (WCGIC 2017). LMR > 2.6 was associated with significant improvement of overall survival after short-course radiotherapy (5x5 Gy) and consolidating chemotherapy when compared to chemoradiotherapy (HR 0.36). To our knowledge this is the first observation on use of a predictive biomarker for hypofractionated radiotherapy. In this study we assessed the intra-patient variability of pre-treatment LMR in order to evaluate its reproducibility. Methods: Patients with rectal cancer treated in Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland between January 2013 and August 2017 were identified. In order to test reproducibility of the biomarker, only the patients with minimum two peripheral blood morphology tests within 5 weeks prior to any anti-cancer therapy were selected. Other inclusion criteria were locally advanced rectal cancer with no distant metastasis; no prior radiotherapy or chemotherapy. Patients with LMR > 2.6 were identified as “LMR high”. Results: After pre-screening of 719 rectal cancer patients, 50 patients met the inclusion criteria. LMRs calculated at two time-points were correlated with the coefficient of 0.588 (p < 0.05). 40% of assessments were “LMR high”. In 18% of patients the second test has not confirmed initial assignment to LMR class (95% CI 8.6%-31.4%). If LMR at the first time-point was in the range of 2.2-3.0 (+/- 0.4 from cut off), the chance for misclassification rose to 40% (95% CI 12.2%-73.8%), while outside of this range it dropped to 7.5% (95% CI 1.6%-20.4%). Conclusions: In our study LMR demonstrated significant intra-patient variability, espetially in patients with LMR outside of the indicated range (2.2-3.0). Further translational research is needed to identify the exact biological context of this biomarker in order to identify the molecular subtype of rectal cancer responding to hypofractionated radiotherapy.

A Prospective Study on the Roles of the Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) in Patients with Locally Advanced Rectal Cancer

“…However, if the first measurement was out of the range of approximately ±15% from the cut-off, the risk of misclassification in the second measurement dropped significantly, and in terms of the LMR, this dropped to 5% (95% CI, 1.0-13.9%), while for the NLR, it dropped to 8.3% (95% CI, 2.8-18.4%), and for the PLR, it dropped to 10% (95% CI, 3.8-20.5%). These results were in line with our previous retrospective study on the reproducibility of the LMR in patients with LARC, where two peripheral blood tests within five weeks prior to beginning anti-cancer therapies were performed [20]. The stability of the NLR over time, up to 100 days, has been demonstrated in cardiac surgery patients; however, it has not been confirmed in a cancer population [36].…”

“…The patients were divided in terms of the baseline values of their SIR markers into high and low LMR, NLR, and PLR groups. The cut-off values were determined based on our previous studies and the data available in the literature [17][18][19][20].…”

Reproducibility of lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with locally advanced rectal cancer.

“…The same percentage of patients (18%) as in the current study had not been re-assigned to the LMR group in the second test (95% CI, 8.6-31.4%). The chance for misclassi cation was 7.5% (95% CI, 1.6-20.4%) if LMR in the rst measurement was outside of the range of 2.2-3.0 compared to 5% (95% CI, 1.0-13.9%) in our current study [11]. The stability of NLR over time, up to 100 days, was demonstrated in cardiac surgery patients, it was not con rmed in cancer population, though [15].…”

“…Patients were divided in terms of baseline values of SIR markers into LMR,NLR,PLR-high and low groups. The cut-off values were determined based on our previous studies and data available in the literature [4,6,10,11].…”

Correlation between Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Tumor-Infiltrating Lymphocytes (TILs) in Left-Sided Colorectal Cancer Patients

“…The patients were divided in terms of pre-treatment values of SIR markers. The cut-off values were predetermined based on available data in the literature and our previous studies [4,6,8,9]. For LMR, the cut-off value was 2.6, for NLR 3.0 and for PLR 150.…”