Prognostic significance of the lymphocyte-to-monocyte ratio in patients with metastatic colorectal cancer

Table 1 Patient characteristics

Age (yr)
Median (range)	64 (27-86)
Gender
Male	59
Female	45
Performance status
0	96
1	6
2	2
Location of primary tumor
Colon	60
Rectum	44
Histological type
Well, moderately	81
Poorly, mucinous	14
KRAS
Wild type	25
Mutant type	25
Unknown	54
Detection of unresectable tumor
Synchronous	62
Metachronous	42
Number of organs affected by metastasis
One organ	58
More than one organ	46
Resection of primary tumor
No	16
Yes	88
Regimen of first-line chemotherapy
FOLFOX	64
CapeOX	26
FOLFIRI	9
SOX	5
Molecular targeted therapy
No	28
Yes	76
Pre-treatment LMR (mean ± SD)	4.548 ± 2.314
Pre-treatment NLR (mean ± SD)	3.204 ± 2.284

FOLFOX: 5-fluorouracil + leucovorin + oxaliplatin; CapeOX: Capecitabine + oxaliplatin; FOLFIRI: 5-fluorouracil + leucovorin + irinotecan; SOX: S-1 + oxaliplatin; LMR: Lymphocyte to monocyte ratio; NLR: Neutrophil to lymphocyte ratio.

Table 2 Correlations between the pre-treatment lymphocyte to monocyte ratio and clinicopathological factors

	Pre-treatment LMR
	High	Low	P value
Performance status
0	62	34
1, 2	4	4	0.459
Location of primary tumor
Colon	39	21
Rectum	27	17	0.837
Detection of unresectable tumor
Synchronous	39	23
Metachronous	27	15	1.000
Resection of primary tumor
No	8	8
Yes	58	30	0.264
Histological type
Well, moderately	51	30
Poorly, mucinous	10	4	0.764
KRAS
Wild type	15	10
Mutant type	15	10	1.000
Peritoneal dissemination
Negative	53	32
Positive	13	6	0.793
Number of organs affected by metastasis
One organ	39	19
More than one organ	27	19	0.416
Pre-treatment CEA (ng/mL)
≤ 5	10	3
> 5	54	35	0.362
Average relative dose intensity (%)
Median (range)	100 (60.0-100)	96.2 (50.0-100)	0.697
Molecular targeted therapy
No	15	13
Yes	51	25	0.253
Pre-treatment NLR
< 2.8	48	5
≥ 2.8	18	33	< 0.001

CEA: Carcinoembryonic antigen; LMR: Lymphocyte to monocyte ratio; NLR: Neutrophil to lymphocyte ratio.

Table 3 Treatment response to chemotherapy according to the pre-treatment lymphocyte to monocyte ratio/neutrophil to lymphocyte ratio

Response	LMR			NLR
	High (n = 64)	Low (n = 38)	P value	High (n = 51)	Low (n = 51)	P value
CR	2	2		2	2
PR	20	9		12	17
SD	31	13		22	22
PD	11	14		15	10
Objective response rate	34.4%	28.9%	0.664	27.5%	37.3%	0.397
Disease control rate	82.8%	63.2%	0.033	70.6%	80.4%	0.357

CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; LMR: Lymphocyte to monocyte ratio; NLR: Neutrophil to lymphocyte ratio.

Table 4 Correlations between overall survival and various clinicopathological factors

	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Performance status (≥ 1)	3.821	1.805-8.087	< 0.001	3.345	1.558-7.182	0.002
Location of primary tumor (colon)	1.405	0.857-2.304	0.177
Detection of unresectable tumor (synchronous)	1.407	0.852-2.312	0.182
Histological type (poorly, mucinous)	1.283	0.644-2.556	0.478
Peritoneal dissemination (yes)	0.981	0.534-1.802	0.951
Number of organs affected by metastasis (≥ 2)	1.637	1.012-2.648	0.045	1.270	0.737-2.187	0.389
Pre-treatment CEA (> 5 ng/mL)	1.949	0.841-4.521	0.120
Resection of primary tumor (no)	1.716	0.948-3.104	0.074	1.736	0.871-3.459	0.117
Molecular targeted therapy (yes)	0.496	0.289-0.853	0.011	0.462	0.263-0.813	0.007
Response to chemotherapy (CR, PR)	0.459	0.264-0.797	0.006	0.432	0.244-0.765	0.004
Pre-treatment LMR (< 3.38)	2.273	1.368-3.777	0.002	1.734	0.942-3.192	0.077
Pre-treatment NLR (< 2.8)	2.578	1.569-4.237	< 0.001	1.734	0.947-3.178	0.075

CEA: Carcinoembryonic antigen; CR: Complete response; PR: Partial response; LMR: Lymphocyte to monocyte ratio; NLR: Neutrophil to lymphocyte ratio.

Table 5 Pre-treatment and post-treatment absolute neutrophil/lymphocyte/monocyte counts

	Pre-treatment value	Post-treatment value	P value
All patients
Neutrophil (mean ± SD)	4538.5 ± 200.4	2798.0 ± 190.0	< 0.001
Lymphocyte (mean ± SD)	1664.3 ± 649.1	1610.5 ± 671.0	0.247
Monocyte (mean ± SD)	422.1 ± 19.0	471.7 ± 24.6	0.027
Patients receiving chemotherapy based on oxaliplatin
Neutrophil (mean ± SD)	4455.8 ± 1962.6	2791.7 ± 1859.9	< 0.001
Lymphocyte (mean ± SD)	1694.9 ± 695.4	1639.2 ± 677.8	0.365
Monocyte (mean ± SD)	412.4 ± 181.0	457.3 ± 248.4	0.001
Patients receiving chemotherapy based on irinotecan
Neutrophil (mean ± SD)	4567.6 ± 1873.2	2879.4 ± 2007.3	0.038
Lymphocyte (mean ± SD)	1307.5 ± 440.8	1238.6 ± 342.1	0.394
Monocyte (mean ± SD)	466.9 ± 221.0	427.0 ± 134.2	0.174