Volume 3 · Issue 6 (2026)
DOI number:
10.66521/2938-9933-2026063001
Prognostic Value of Lymphocyte-to-Monocyte Ratio in Locally Advanced and Metastatic Esophageal Cancer
Zipei Chen
Department of Medical Oncology, Guangdong Engineering Research Center of AI-Powered Precision Cancer Diagnostics and Therapeutics (Proposed) / GuangDong Engineering Technology Research Center of AI-Powered Precision Cancer Diagnostics and Therapeutics, Cancer Hospital of Shantou University Medical College, Guangdong, China
Abstract: Objective: To explore the prognostic value of pre-treatment lymphocyte-to-monocyte ratio (LMR) in peripheral blood for patients with locally advanced and metastatic esophageal cancer. Methods: A retrospective analysis was conducted on the clinical data of 155 patients with locally advanced or metastatic esophageal cancer who received chemoradiotherapy or chemotherapy alone at the Cancer Hospital of Shantou University Medical College from January 2008 to December 2012. The optimal cutoff value for LMR was determined using receiver operating characteristic (ROC) curves. Survival curves were plotted using the Kaplan-Meier method, and univariate analysis was performed using the Log-rank test. Multivariate analysis was carried out using the Cox proportional hazards regression model, and stratified analyses were also conducted. Results: The optimal cutoff value for LMR was 3.06, with a sensitivity of 69.2% and a specificity of 62.9% in predicting overall survival. In the low-LMR group (<3.06), the median overall survival was 11.0 months, significantly shorter than the 17.0 months observed in the high-LMR group (≥3.06) (P<0.001). Multivariate analysis revealed that LMR, tumor location, and TNM stage were independent prognostic factors for esophageal cancer patients (P<0.001). Stratified analysis showed that, across various subgroups defined by tumor stage, histological type, tumor location, and treatment regimen, the low-LMR group consistently had significantly poorer outcomes compared to the high-LMR group (P<0.05).
Conclusion: Pre-treatment peripheral blood LMR is an effective indicator for assessing the prognosis of patients with locally advanced and metastatic esophageal cancer; a low LMR suggests a poorer prognosis.
Keywords: Lymphocyte-to-monocyte ratio; Esophageal cancer; Prognosis; Inflammation; Immunity
References
[1]
Bray, F., Laversanne, M., Sung, H., et al. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 74(3), 229–263. https://doi.org/10.3322/caac.21834
[2]
Hanahan, D., & Weinberg, R. A. (2011). Hallmarks of cancer: the next generation. Cell, 144(5), 646–674. https://doi.org/10.1016/j.cell.2011.02.013
[3]
Grivennikov, S. I., Greten, F. R., & Karin, M. (2010). Immunity, inflammation, and cancer. Cell, 140(6), 883–899. https://doi.org/10.1016/j.cell.2010.01.025
[4]
Li, Y., Wang, H., Zhao, X., et al. (2025). Prognostic value of immunotrophic inflammatory markers in ESCC undergoing chemoradiotherapy combined with immunotherapy. Sci Rep, 15(1), 18258. https://doi.org/10.1038/s41598-025-02454-5
[5]
Gu, L., Li, H., Chen, L., et al. (2016). Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis. Oncotarget, 7(22), 31926–31942. https://doi.org/10.18632/oncotarget.7876
[6]
Jin, J., Yang, L., Liu, D., et al. (2021). Prognostic Value of Pretreatment Lymphocyte-to-Monocyte Ratio in Lung Cancer: A Systematic Review and Meta-Analysis. Technol Cancer Res Treat, 20, 1533033820983085. https://doi.org/10.1177/1533033820983085
[7]
Zhu, L., Qiao, J., Yang, C., et al. (2025). Prognostic value of lymphocyte-to-monocyte ratio for breast cancer: a systematic review and meta-analysis. BMC Womens Health, 25(1), 569. https://doi.org/10.1186/s12905-025-04120-4
[8]
Tan, D., Fu, Y., Tong, W., et al. (2018). Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: A meta-analysis. Int J Surg, 55, 128–138. https://doi.org/10.1016/j.ijsu.2018.05.030
[9]
Huang, Y., & Feng, J. F. (2015). Low preoperative lymphocyte to monocyte ratio predicts poor cancer-specific survival in patients with esophageal squamous cell carcinoma. Onco Targets Ther, 8, 137–145. https://doi.org/10.2147/ott.S73794
[10]
Han, L. H., Jia, Y. B., Song, Q. X., et al. (2015). Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 16(6), 2245–2250. https://doi.org/10.7314/apjcp.2015.16.6.2245
[11]
Hirahara, N., Matsubara, T., Kawahara, D., et al. (2017). Prognostic significance of preoperative inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma. Eur J Surg Oncol, 43(2), 493–501. https://doi.org/10.1016/j.ejso.2016.11.018
[12]
Sang, B., Fan, Y., Wang, X., et al. (2024). The prognostic value of absolute lymphocyte count and neutrophil-to-lymphocyte ratio for patients with metastatic breast cancer: a systematic review and meta-analysis. Front Oncol, 14, 1360975. https://doi.org/10.3389/fonc.2024.1360975
[13]
Zhang, M., Xie, C., Liu, S., et al. (2025). The Prognostic Value of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score in Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med, 14(16). https://doi.org/10.3390/jcm14165701
[14]
Ono, K., & Momen-Heravi, F. (2026). Tumor-Associated Macrophages (TAMs) in Cancer: Functional Programs, Metastatic Mechanisms, and Therapeutic Targeting. Cancers (Basel), 18(9). https://doi.org/10.3390/cancers18091410
[15]
Shibutani, M., Maeda, K., Nagahara, H., et al. (2017). The peripheral monocyte count is associated with the density of tumor-associated macrophages in the tumor microenvironment of colorectal cancer: a retrospective study. BMC Cancer, 17(1), 404. https://doi.org/10.1186/s12885-017-3395-1
Download PDF