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

doi:10.4240/wjgs.v15.i8.1673

Prognostic significance of preoperative lymphocyte to monocyte ratio in patients with signet ring gastric cancer

World J Gastrointest Surg. 2023 Aug 27;15(8):1673-1683. doi: 10.4240/wjgs.v15.i8.1673.

Authors

He-Li Liu^{1

2}, Xiang Feng¹, Mi-Mi Tang³, Hai-Yan Zhou⁴, Huan Peng⁵, Jie Ge⁶, Ting Liu³

Affiliations

¹ Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China.
² 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.
³ Institute for Rational and Safe Medication Practices National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China.
⁴ Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China.
⁵ Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China.
⁶ Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China. gejie@csu.edu.cn.

Abstract

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.

Keywords: Coagulation indexes; Gastric cancer; Inflammation indexes; Prognosis.; Signet ring cell carcinoma.