Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2017; 8(1): 60-66
Published online Feb 6, 2017. doi: 10.4292/wjgpt.v8.i1.60
Lymphocyte-to-monocyte ratio can predict mortality in pancreatic adenocarcinoma
Gurshawn Singh, Ammar Nassri, David Kim, Hong Zhu, Zeeshan Ramzan
Gurshawn Singh, Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States
Ammar Nassri, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX 78701, United States
David Kim, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, United States
Hong Zhu, Department of Clinical Science, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX 75390, United States
Zeeshan Ramzan, Gastrointestinal Section, Department of Internal Medicine, VA North Texas Healthcare System, Dallas, TX 75216, United States
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: The study was reviewed and approved by the VA North Texas Health Care System Institutional Review Board.
Informed consent statement: All study data was de-identified and was approved by the institutional review board.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No data were created no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zeeshan Ramzan, MD, Assistant Professor, Gastrointestinal Section, Department of Internal Medicine, VA North Texas Healthcare System, 4500 South Lancaster Rd, Dallas, TX 75216, United States. zeeshanramzan@hotmail.com
Telephone: +1-214-8571603
Received: August 30, 2016
Peer-review started: September 1, 2016
First decision: September 29, 2016
Revised: October 30, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: February 6, 2017
Processing time: 144 Days and 16.3 Hours
Abstract
AIM

To determine if the lymphocyte-to-monocyte ratio (LMR) could be helpful in predicting survival in patients with pancreatic adenocarcinoma.

METHODS

We retrospectively reviewed the medical records of all patients diagnosed with pancreatic adenocarcinoma in the VA North Texas Healthcare System from January 2005 to December 2010. The LMR was calculated from peripheral blood cell counts obtained at the time of diagnosis of pancreatic cancer by dividing the absolute lymphocyte count by the absolute monocyte count. A Univariable Cox regression analysis was performed using these data, and hazard ratios (HR) and 95%CI were calculated. The median LMR (2.05) was used to dichotomize patients into high-LMR and low-LMR groups and the log rank test was used to compare survival between the two groups.

RESULTS

We identified 97 patients with pancreatic adenocarcinoma (all men, 66% white, 30% African-American). The mean age and weight at diagnosis were 66.0 ± 0.9 (SEM) years and 80.4 ± 1.7 kg respectively. Mean absolute lymphocyte and monocyte values were 1.50 ± 0.07 K/μL and 0.74 ± 0.03 K/μL respectively. Mean, median and range of LMR was 2.36, 2.05 and 0.4-12 respectively. In the univariable Cox regression analysis, we found that an increased LMR was a significant indicator of improved overall survival in patients with pancreatic adenocarcinoma (HR = 0.83; 95%CI: 0.70-0.98; P = 0.027). Kaplan-Meier analysis revealed an overall median survival of 128 d (95%CI: 80-162 d). The median survival of patients in the high-LMR (> 2.05) group was significantly greater than the low-LMR group (≤ 2.05) (194 d vs 93 d; P = 0.03), validating a significant survival advantage in patients with a high LMR.

CONCLUSION

The LMR at diagnosis is a significant predictor for survival and can provide useful prognostic information in the management of patients with pancreatic adenocarcinoma.

Keywords: Prognosis; Lymphocyte-to-monocyte ratio; Pancreatic adenocarcinoma; Mortality; Biomarker

Core tip: Pancreatic adenocarcinoma is an aggressive malignancy and many patients are presented with aggressive treatment options at diagnosis; often times they are unsure whether they should take a palliative route or a more aggressive approach to their care. Through a retrospective analysis of patients with pancreatic adenocarcinoma, we found that a higher lymphocyte-to-monocyte ratio is associated with improved survival. The lymphocyte-to-monocyte ratio was collected at diagnosis, and is readily available on routine blood work, making it a simple way to help predict and guide treatment in patients diagnosed with pancreatic adenocarcinoma.