ReviewLymphocyte-to-monocyte ratio in pancreatic cancer: Prognostic significance and meta-analysis
Introduction
Pancreatic cancer (PC) is one of the most fatal malignant cancers worldwide [1]. Surgical resection remains the mainstay of curative treatment for PC. However, the benefits of surgery are greatly limited by the fact that patients with PC are usually diagnosed at an advanced stage [2,3]. Despite numerous progresses were achieved due to large amounts of molecular data and clinical evidence of unprecedented depth and width in cancer research, the overall prognosis of PC remains poor because of the non-specific symptoms and high recurrence rate after curative resection. Data from the Surveillance, Epidemiology, and End Results (SEER) program (2006–2012) demonstrates that the 5-year survival of patients with PC is 7.7%. Therefore, it is vital to develop novel, independent biomarkers for the implementation of better therapeutic and prognostic strategies.
Emerging evidence has highlighted the role of inflammation as a critical component in tumor development and progression [4]. Systemic inflammation biomarkers such as the Glasgow Prognostic Score (mGPS), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been identified as prognostic indicators in various cancers [[5], [6], [7], [8]]. Recently, the pretreatment lymphocyte-to-monocyte ratio (LMR) has been found to be associated with prognosis in patients with PC [[9], [10], [11]]. Nonetheless, the prognostic value of LMR in PC is still controversial [12,13]. Therefore, an integrated meta-analysis was performed to assess the clinicopathological and prognostic value of pretreatment LMR in PC patients.
Section snippets
Search strategy
A comprehensive literature (up to December 2017) was performed using the MEDLINE, EMBASE, and Cochrane databases. Search keywords or their combinations were: (pancreatic ductal adenocarcinoma or PDAC or pancreatic cancer or pancreatic adenocarcinoma) AND (lymphocyte-to-monocyte ratio or lymphocyte monocyte ratio or lymphocyte to monocyte ratio or LMR). Pertinent references were retrieved through manual searches on the above mentioned websites.
Study selection
Inclusion criteria for the eligible studies
Search results
A total of 48 records were identified from an initial comprehensive literature research. The removal of duplicates yielded 28 articles for further screening. After careful reviews of the titles and abstracts, 13 articles were excluded. Subsequently, 15 full-text articles were further evaluated for eligibility. Finally, 10 studies (11 cohorts), comprising a total of 2557 patients, were included in the quantitative synthesis [3,[9], [10], [11], [12], [13],[20], [21], [22], [23]]. The selection
Discussion
In the present study, we identified 10 studies that involved 2557 patients, and we investigated prognostic value of LMR in PC. The result demonstrated that the presence of low LMR significantly worse OS and DFS/RFS in PC. Subgroup analyses demonstrated that the unfavorable prognostic impact of low LMR on OS remained substantial in patients with advanced and mixed disease. Stratified analysis also indicated that low LMR was significantly correlated with worse OS in patients with PC, irrespective
Acknowledgments
The authors gratefully acknowledge Elsevier for language editing.
Author contributions
Conception and design: Ru-jin Hu, Jian-ying Ma, Gang Hu.
Collection and assembly of data: Ru-jin Hu, Jian-ying Ma.
Data analysis and interpretation: Ru-jin Hu, Jian-ying Ma, Gang Hu.
Manuscript writing: All authors.
Final approval of manuscript: All authors.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Funding
None.
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These authors contributed equally to this work