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      • Record: found
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      Prognostic impact of pretreatment lymphocyte-to-monocyte ratio in advanced epithelial cancers: a meta-analysis

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          Abstract

          Background

          There is increasing evidence that inflammation-based biomarkers are associated with tumor microenvironment which plays important roles in cancer progression. A high lymphocyte-to-monocyte ratio (LMR), has been suggested to indicate favorable prognoses in various epithelial cancers. We performed a meta-analysis to quantify the prognostic value of LMR in advanced-stage epithelial cancers undergoing various treatment.

          Methods

          We searched PubMed, EMBASE, Web of science and Cochrane Library up to July 2018 for relevant studies. We included studies assessing the prognostic impact of pretreatment LMR on clinical outcomes in patients with advanced-stage epithelial cancers. The primary outcome was overall survival (OS) and the secondary outcome was progression free survival (PFS). The summary hazard ratio (HR) and 95% confidence interval (CI) were calculated.

          Results

          A total of 8984 patients from 35 studies were included. A high pretreatment LMR was associated with favorable OS (HR = 0.578, 95% CI 0.522–0.641, P < 0.001) and PFS (HR = 0.598, 95% CI 0.465–0.768, P < 0.001). The effect of LMR on OS was observed among various tumor types. A higher pretreatment LMR was associated with improved OS in chemotherapy (n = 10, HR = 0.592, 95% CI 0.518–0.676, P < 0.001), surgery (n = 10, HR = 0.683, 95% CI 0.579–0.807, P < 0.001) and combined therapy (n = 11, HR = 0.507, 95% CI 0.442–0.582, P < 0.001) in the subgroup analysis by different therapeutic strategies. The cut-off value for LMR was 3.0 (range = 2.35–5.46). Subgroup analysis according to the cut-off value showed a significant prognostic value of LMR on OS and PFS in both subgroups.

          Conclusions

          A high pretreatment LMR is associated with favorable clinical outcomes in advanced-stage epithelial cancers undergoing different therapeutic strategies. LMR could be used to improve clinical decision-making regarding treatment in advanced epithelial cancers.

          Electronic supplementary material

          The online version of this article (10.1186/s12935-018-0698-5) contains supplementary material, which is available to authorized users.

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          Most cited references42

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          Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.

          M Parmar, V. Torri, L. Stewart (1998)
          Meta-analyses aim to provide a full and comprehensive summary of related studies which have addressed a similar question. When the studies involve time to event (survival-type) data the most appropriate statistics to use are the log hazard ratio and its variance. However, these are not always explicitly presented for each study. In this paper a number of methods of extracting estimates of these statistics in a variety of situations are presented. Use of these methods should improve the efficiency and reliability of meta-analyses of the published literature with survival-type endpoints.
          Article 0 comments Cited 835 times – based on 0 reviews     Review now
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            The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses.

            W Melsen, M Bonten, M Rovers … (2014)
            Variance between studies in a meta-analysis will exist. This heterogeneity may be of clinical, methodological or statistical origin. The last of these is quantified by the I(2) -statistic. We investigated, using simulated studies, the accuracy of I(2) in the assessment of heterogeneity and the effects of heterogeneity on the predictive value of meta-analyses. The relevance of quantifying I(2) was determined according to the likely presence of heterogeneity between studies (low, high, or unknown) and the calculated I(2) (low or high). The findings were illustrated by published meta-analyses of selective digestive decontamination and weaning protocols. As expected, I(2) increases and the likelihood of drawing correct inferences from a meta-analysis decreases with increasing heterogeneity. With low levels of heterogeneity, I(2) does not appear to be predictive of the accuracy of the meta-analysis result. With high levels of heterogeneity, even meta-analyses with low I(2) -values have low predictive values. Most commonly, the level of heterogeneity in a meta-analysis will be unknown. In these scenarios, I(2) determination may help to identify estimates with low predictive values (high I(2) ). In this situation, the results of a meta-analysis will be unreliable. With low I(2) -values and unknown levels of heterogeneity, predictive values of pooled estimates may range extensively, and findings should be interpreted with caution. In conclusion, quantifying statistical heterogeneity through I(2) -statistics is only helpful when the amount of clinical heterogeneity is unknown and I(2) is high. Objective methods to quantify the levels of clinical and methodological heterogeneity are urgently needed to allow reliable determination of the accuracy of meta-analyses.
            Article 0 comments Cited 283 times – based on 0 reviews     Review now
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              Improving immune–vascular crosstalk for cancer immunotherapy

              Yuhui Huang, Betty Kim, Charles Chan … (2018)
              The vasculature of tumours is highly abnormal and dysfunctional. Consequently, immune effector cells have an impaired ability to penetrate into solid tumours and often exhibit compromised functions. Normalization of the tumour vasculature can enhance tissue perfusion and improve immune effector cell infiltration, leading to immunotherapy potentiation. However, recent studies, have demonstrated that stimulation of immune cell functions can also help to normalize tumour vessels. In this Opinion article, we propose that the reciprocal regulation between tumour vascular normalization and immune reprogramming forms a reinforcing loop that reconditions the tumour immune microenvironment to induce durable antitumour immunity. A deeper understanding of these pathways could pave the way for identifying new biomarkers and developing more effective combination treatment strategies for patients with cancer.
              Article 0 comments Cited 222 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yiming Mao: 253992240@qq.com
                Donglai Chen: allen_stcdl2006@163.com
                Shanzhou Duan: dydsxjx@163.com
                Yuhuan Zhao: 1264689322@qq.com
                Changjiang Wu: fancysuxing@163.com
                Feng Zhu: 52463822@qq.com
                Chang Chen: chenthoracic@163.com
                Yongbing Chen: chentongt@sina.com
                Journal
                Journal ID (nlm-ta): Cancer Cell Int
                Journal ID (iso-abbrev): Cancer Cell Int
                Title: Cancer Cell International
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1475-2867
                Publication date (Electronic): 6 December 2018
                Publication date PMC-release: 6 December 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 201
                Affiliations
                [1 ]ISNI 0000 0004 1762 8363, GRID grid.452666.5, Department of Thoracic Surgery, , The Second Affiliated Hospital of Soochow University, ; 1055 Sanxiang Road, Gusu District, Suzhou, 215004 China
                [2 ]GRID grid.412532.3, Department of Thoracic Surgery, , Shanghai Pulmonary Hospital, Tongji University, School of Medicine, ; 507 Zhengming Road, Yangpu District, Shanghai, 200433 China
                [3 ]GRID grid.459966.1, Department of Thoracic Surgery, , Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, ; Suzhou, China
                [4 ]GRID grid.459966.1, Department of Intensive Care Unit, , Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, ; Suzhou, China
                Article
                Publisher ID: 698
                DOI: 10.1186/s12935-018-0698-5
                PMC ID: 6282251
                SO-VID: 8d9f1bf3-afa4-474b-b5f4-15c38fbc9934
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 25 September 2018
                Date accepted : 2 December 2018
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: lymphocyte-to-monocyte ratio,prognosis,epithelial cancer,treatment
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: lymphocyte-to-monocyte ratio, prognosis, epithelial cancer, treatment

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