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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic significance of preoperative lymphocyte to monocyte ratio in patients with signet ring gastric cancer
He-Li Liu, Xiang Feng, Mi-Mi Tang, Hai-Yan Zhou, Huan Peng, Jie Ge, Ting Liu
He-Li Liu, Xiang Feng, Jie Ge, Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
He-Li Liu, The Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment for Gastrointestinal Tumor, The Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Changsha 410008, Hunan Province, China
Mi-Mi Tang, Ting Liu, Institute for Rational and Safe Medication Practices National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Hai-Yan Zhou, Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Huan Peng, Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Author contributions: Liu HL, Feng X contributed equally to this work; Liu HL, Feng X and Ge J designed research; Tang MM, Zhou HY and Feng X collected and analyzed clinical data; Liu T, Peng H wrote the paper.
Supported by the Clinical Research Fund of National Geriatric Disease Clinical Medical Research Center, No. 2022LNJ22; Guangdong Yiyang Healthcare Charity Foundation, No. JZ2022014.
Institutional review board statement: The study was reviewed and approved by the Xiangya Hospital, Central South University Institutional Review Board [Approval No. Xykyll-lx-2019030510].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jie Ge, MD, Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China. gejie@csu.edu.cn
Received: May 6, 2023
Peer-review started: May 6, 2023
First decision: May 19, 2023
Revised: May 31, 2023
Accepted: June 21, 2023
Article in press: June 21, 2023
Published online: August 27, 2023
BACKGROUND
The ratio of lymphocytes to monocytes (LMR) has been shown to be an effective predictor of gastric cancer prognosis. However, its predictive accuracy for signet ring gastric cancer is currently not well understood.
AIM
To evaluate the prognosis predictive accuracy of preoperative LMR in signet ring gastric cancer.
METHODS
A total of 212 signet ring gastric cancer patients admitted at the Xiangya Hospital of Central South University, Department of Gastrointestinal Surgery, from January 2012 to December 2016 were enrolled in the study. The prognosis predictive accuracy of preoperative LMR was explored based on the area under the receiver operating characteristic. Factors that significantly affect the survival of patients were identified using single factor analysis, and those that were independently associated with signet ring gastric cancer were identified through multivariate analysis.
RESULTS
The results of the single factor analysis revealed a strong correlation between the survival of signet ring gastric cancer patients and several factors, including tumor invasion (χ2 = 49.726; P < 0.001), lymph node metastasis (χ2 = 30.269; P < 0.001), pTNM stage (χ2 = 49.322; P < 0.001), surgical approach (χ2 = 8.489; P = 0.004), age (t = -2.213; P < 0.028), carcinoembryonic antigen (CEA) (Z = -3.265; P = 0.001), platelet-to-lymphocyte ratio (Z = -2.196; P = 0.028), LMR (Z = -2.226; P = 0.026), ALB (t = 3.284; P = 0.001), prognostic nutritional index (t = -3.789; P < 0.001) and FIB (Z = -3.065; P = 0.002). Furthermore, the multivariate analysis further demonstrated that age (HR: 0.563, 95%CI: 0.363-0.873), tumor invasion depth (HR: 0.226, 95%CI: 0.098-0.520), pTNM stage (HR: 0.444, 95%CI: 0.255-0.771), preoperative CEA level (HR: 0.597, 95%CI: 0.386-8.790), and preoperative LMR level (HR: 1.776, 95%CI: 1.150-2.741) were independent factors influencing the prognosis of signet ring gastric cancer.
CONCLUSION
In signet ring gastric cancer patients, a low preoperative LMR level predicts poor prognosis. The death risk ratio of the low LMR group compared to the high LMR group is 1.776.
Core Tip: Low preoperative lymphocytes to monocytes levels -predict poor prognosis of patients with signet ring gastric cancer, making it a valuable prognostic factor.
