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In the non-specific immune system of human, neutrophils, lymphocytes, monocytes and platelets are important components that play a role in regulating and inducing tissue damage and can reflect the body′s level of immunity.These peripheral blood cells are functionally and quantitatively abnormal in the presence of serious infections or immune deficiencies, but these parameters are usually interpreted in isolation.Recent studies have found that comprehensive indicators derived from peripheral blood parameters, such as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio or lymphocyte to monocyte ratio have predictive value for the occurrence and prognosis of diseases.This article reviews the role of these indicators in common childhood diseases and provides a reference for the diagnosis and treatment of some diseases.
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Objective:To determine the predictive value of preoperative monocyte-to-lymphocyte ratio(MLR) for prognosis in elderly patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy(RNU).Methods:A retrospective study was performed on 168 elderly patients who underwent RNU in Beijing Hospital between March 2004 to February 2019.Males accounted for 44.6% (75 patients) and females 55.4%(93 patients) of the patients. Median age at the time of surgery was 73(69-78) years, and 110 (65.5%) patients suffered from hydronephrosis. There were 147 cases(87.5%)with single tumor, and 21 cases(12.5%)with multiple tumors, including 75(46.6%) cases in renal pelvis or pelvi-ureteric junction, and 93(53.4%)cases in ureter. Open RNU was performed in 106(63.1%) patients, and laparoscopic method in 62(32.9%) patients. The optimal cutoff value of MLR was set as 0.22 by using the median.χ 2 test, which was used to detect the association between MLR(≤0.22 vs.>0.22) and clinicopathological variables. Survival analyses were performed using the Kaplan-Meier method and were compared using the log-rank test. Additional subgroup analyses(low grade vs. high grade) were performed according to pathological grade. Univariate and multivariate analysis by Cox’s proportional hazards model was used to determine the significance of MLR in respect to OS and PFS. Results:The follow-up period ranged from 19.2 to 86.9 months (median 51.9 months). Next, the cohort was divided into 2 groups , including 77 patients with low MLR(≤0.22) and 91 patients with high MLR(>0.22). High MLR was significantly more frequent in male patients(31.2% vs.56.0%), as well as those undergoing laparoscopic surgery (54.5% vs.70.3%)(All P<0.05). Based on a Cox univariate proportional hazards analysis, male gender( HR=1.793, 95% CI 1.003-3.205, P=0.049), presence of lymph node metastasis( HR=6.809, 95% CI 2.124-17.454, P=0.001) and high MLR( HR=2.287, 95% CI 1.259-4.154, P=0.007)were associated with poor OS. Male gender( HR=1.758, 95% CI 1.066-2.902, P=0.027), presence of lymph node metastasis( HR=6.524, 95% CI 2.542-16.748, P<0.001), lymphovascular invasion(LVI) ( HR=2.348, 95% CI 1.139-4.838, P=0.021), high MLR( HR=2.801, 95% CI 1.657-4.735, P<0.001)and PLR( HR=1.663, 95% CI 1.003-2.757, P=0.049) were significantly associated with subsequent PFS. By multivariate analysis, tumor site( HR=2.050, 95% CI 1.079-3.892, P=0.028), lymph node metastasis ( HR=6.641, 95% CI 1.852-23.811, P=0.004) and MLR( HR=2.089, 95% CI 1.062-4.113, P=0.033) were the independent risk factors for OS in elderly patients with UTUC. Tumor side( HR=2.024, 95% CI 1.033-3.965, P=0.040), multifocality ( HR=2.992, 95% CI 1.161-7.713, P=0.023), lymph node metastasis ( HR=6.454, 95% CI 2.026-20.564, P=0.002) and MLR( HR=2.866, 95% CI 1.554-5.284, P=0.001) were associated with PFS.The multivariate analysis of the significant risk factors established a postoperative risk stratification model for OS and PFS. The results showed significant differences among the 3 subgroups of patients with low(0 risk factor), intermediate(1 risk factor), or high risk(2-3 risk factors)(All P<0.05). Conclusion:MLR was an independent risk factor for OS and PFS in elderly patients with UTUC and patients with elevated MLR have worsen prognosis.
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Objective:To investigate the prognostic value of peripheral blood monocyte to lymphocyte ratio (MLR) combined with fibrinogen (Fbg) in patients with epithelial ovarian cancer (EOC) before operation.Methods:Retrospectively included 80 patients with EOC who underwent surgical treatment at Gaochun Branch of Nanjing Drum Tower Hospital from January 2014 to January 2017. The boundary values of MLR and Fbg were determined by the receiver operating characteristic(ROC) curve, and then grouped by the critical value. The patients were evaluated with age, FIGO stage, lymphatic metastasis, and venous metastasis between groups. The 5-year cumulativesurvival rate was analyzed among the groups, and the independent risk factors influencing the prognosis of EOC were determined by Cox proportional risk regression model.Results:The predicted cut-off value of MLR was 0.25. Compared with the low MLR group (MLR<0.25, 38 cases), the high MLR group (MLR≥0.25, 42 cases) had a higher rate of lymphatic metastasis and venous metastasis: 33.3%(14/42) vs. 13.2%(5/38), 33.3%(14/42) vs. 10.5%(4/38); and the proportion of patients in stage Ⅲ to Ⅳwas also higher:66.7%(28/42) vs.18.4%(7/38), the differences were statistically significant ( P<0.05). The predicted cut-off value of Fbg concentration was 3.15 g/L. Compared with the low Fbg group (Fbg<3.15 g/L, 43 cases), the high Fbg group (Fbg≥3.15 g/L, 37 cases) had a higher rate of lymphatic metastasis and venous metastasis:35.1%(13/37) vs. 14.0%(6/43), 32.4%(12/37) vs. 14.0%(6/43); and the proportion of patients in stage Ⅲ to Ⅳ was also higher: 70.3%(26/37) vs. 20.9%(9/43), the differences were statistically significant ( P<0.05). At predicted cut-off value of MLR combined with Fbg, the patients were divided into the first group (Fbg<3.15 g/L, MLR<0.25, 27 cases), the second group (Fbg<3.15 g/L, MLR≥0.25 or Fbg≥3.15g/L, MLR<0.25, 31 cases) and the third group (Fbg≥3.15g/L,MLR≥0.25, 22 cases), there were statistically significant differences in the proportion of patients in stage Ⅲ to Ⅳ: 7.4%(2/27), 48.4%(15/31), 81.8%(18/22); venous metastasis: 7.4%(2/27), 19.4%(6/31), 45.5%(10/22); and lymphatic metastasis: 3.7% (1/27), 25.8%(8/31), 45.5%(10/22) among the three groups ( P<0.01). The 5-year cumulative survival rate of EOC patients in the high MLR group was significantly lower than that in the low MLR group:66.7% vs. 89.5%, P<0.05. The 5-year cumulative survival rate of patients in the high Fbg group was significantly lower than that in the low Fbg group :64.9% vs. 88.4%, P<0.05. The 5-year survival rates of EOC patients in the first, second and third groups were 96.3%, 77.4% and 54.5%, respectively, with significant differences among the three groups ( P<0.01). Cox multivariate analysis showed that MLR, Fbg and MLR combined with Fbg were independent risk factors for survival of EOC patients ( P<0.05). Conclusions:Preoperative MLR combined with Fbg was closely related to the tumor progression and prognosis of EOC patients, and it could be used as an effective predictor of the prognosis of EOC patients.
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Objective To investigate the correlation of systemic inflammation parameters including neutrophil to lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with the pregnancy outcome of hypertension disorders of pregnancy.Methods Two hundred and twelve pregnant women in first-trimester with hypertensive disorders and 212 matched healthy subjects (control group) were enrolled in the study.The differences in white blood cell count (WBC),neutrophil (N),lymphocyte (L),monocyte (M),NLR and MLR were compared between groups.Results The WBC,N,M,NLR and MLR values were significantly higher in pregnant women with hypertensive disorders than those in healthy controls (9.1 × 109/L vs.8.5×10g/L,Z=4.89,P＜0.01;6.6× 109/L vs.5.9×109/L,Z=4.33,P＜0.01;0.5×109/L vs.0.4×109/L,Z=3.83,P=0.01;3.7 vs.3.3,Z=1.97,P=0.04;0.3 vs.0.2,Z=3.83,P=0.01).The pregnant women were divided into gestational hypertension group (n=48),mild and severe preeclampsia group (n=77),chronic hypertension with superimposed preeclampsia group (n=55) and chronic hypertension complicating pregnancy group (n=32).There were no significant differences in the WBC,N,L,M,NLR and MLR values among all groups (P＞0.05).Multivariate logistic regression analysis showed that NLR was a predictive factor of hypertensive disorders of pregnancy (OR=1.68,95％CI:1.07-2.62,P＜0.05).Conclusions NLR might be a useful systemic inflammation marker for the prediction of hypertensive disorders in women with early pregnancy.
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Objective@#To investigate the correlation of systemic inflammation parameters including neutrophil to lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with the pregnancy outcome of hypertension disorders of pregnancy.@*Methods@#Two hundred and twelve pregnant women in first-trimester with hypertensive disorders and 212 matched healthy subjects (control group) were enrolled in the study. The differences in white blood cell count (WBC), neutrophil (N), lymphocyte (L), monocyte (M), NLR and MLR were compared between groups.@*Results@#The WBC, N, M, NLR and MLR values were significantly higher in pregnant women with hypertensive disorders than those in healthy controls (9.1×109/L vs.8.5×109/L,Z=4.89, P<0.01; 6.6×109/L vs. 5.9×109/L,Z=4.33, P<0.01; 0.5×109/L vs. 0.4×109/L,Z=3.83, P=0.01; 3.7 vs. 3.3, Z=1.97, P=0.04; 0.3 vs. 0.2, Z=3.83, P=0.01). The pregnant women were divided into gestational hypertension group (n=48), mild and severe preeclampsia group (n=77), chronic hypertension with superimposed preeclampsia group (n=55) and chronic hypertension complicating pregnancy group (n=32). There were no significant differences in the WBC, N, L, M,NLR and MLR values among all groups (P>0.05). Multivariate logistic regression analysis showed that NLR was a predictive factor of hypertensive disorders of pregnancy (OR=1.68, 95%CI: 1.07-2.62, P<0.05).@*Conclusions@#NLR might be a useful systemic inflammation marker for the prediction of hypertensive disorders in women with early pregnancy.
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@# Objective: To explore the relationship between monocyte-to-lymphocyte ratio (MLR) in peripheral blood of patients with pulmonary sarcomatoid carcinoma (PSC) and their clinicopathological features and prognosis, and to investigate its clinical significance. Methods: A retrospective analysis was carried out to analyze the complete case data of 80 patients with PSC from October 2010 to April 2017 in Tianjin Cancer Hospital (monocyte and lymphocyte counts of peripheral blood, clinicopathological features, and survival follow-up). The receiver operating curve (ROC) was used to determine the best cut-off value of MLR for the prediction of overall survival time (OS). The patients were divided into high MLR group and low MLR group. Kaplan-Meier method was used to calculate OS and draw survival curves. The Log-Rank test was used to compare the difference in OS between the two groups. The variables with statistical significance in univariate analysis were included into the COX risk regression model to verify and calculate thehazard ratio (HR)and 95% confidence interval (95%CI). Results: The absolute median values of monocytes and lymphocytes were 0.63×109/L and 1.84×109/L, respectively. The best cut-off value of MLR is 0.44. Univariate analysis shows that MLR≥0.44 (P<0.01), no radical surgery (P<0.01), clinical stage Ⅲ+Ⅳ (P<0.01), tumor maximal diameter > 3 cm (P<0.01), and LDH>247 U /L (P<0.01) are the poor prognostic factors affecting overall survival. Multivariate analysis shows that MLR≥0.44（HR=3.554; 95%CI=1.671-6.125; P<0.01), and clinical stage Ⅲ+Ⅳ（HR=3.275; 95%CI=2.047-9.399; P<0.01) are the independent risk factors for the overall survival of PSC, and radical surgery is an independent protective factor affecting the overall survival of PSC（HR=0.360; 95%CI=0.195-0.848; P<0.01). Conclusion: High MLR is an independent risk factor for poor prognosis in patients with PSC.