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An increase in the peripheral lymphocyte-to-monocyte ratio after primary site resection is associated with a prolonged survival in unresectable colorectal carcinoma

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Abstract

Purpose

The prognostic benefits of primary tumor resection in patients with unresectable distant metastatic colorectal cancer remain unclear. A high pre-treatment lymphocyte-to-monocyte ratio (LMR) was previously shown to be associated with a better prognosis. We assessed whether or not primary tumor resection was associated with an improved survival if the peripheral lymphocyte-to-monocyte ratio increased after primary site resection.

Methods

The survival in 64 and 59 patients with and without primary tumor resection, respectively, was retrospectively compared. After resection, the survival in 39 patients with a postoperatively increased LMR (LMR-increase) and 25 patients with a decreased LMR (LMR-decrease) was compared.

Results

Primary tumor resection prolonged the median survival more frequently in cases of non-differentiated adenocarcinoma, obstructive symptoms, high serum albumin levels, and no lymph-node metastasis than in others. Cox regression showed that the potential independent prognostic variable was non-resection of the primary lesion. After resection, the median survival in the LMR-increase vs. LMR-decrease groups was significantly different (27.3 vs. 20.8 months). There were no marked differences in patient background characteristics between the groups, except for in the number of pre-operative peripheral blood lymphocytes. The resected specimens showed significantly lower CD8+:CD163+ invading leukocyte ratios in the LMR-increase group than in the LMR-decrease group.

Conclusions

Primary tumor resection in patients with unresectable metastatic colorectal cancer may be associated with an improved survival, especially when the LMR is increased after primary tumor resection.

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Acknowledgements

I would like to thank Drs. Yosuke Ohno, MD, PhD, Susumu Shibasaki MD PhD, Naoya Sakamoto, MD, PhD, Professor, Yoshito Komatsu, MD, PhD, Satoshi Yuki, MD, PhD, Hiroshi Nakatsumi, MD, PhD, Yasuyuki Kawamoto, MD, PhD, Shin Emoto, MD, PhD, Tomohiro Ishikawa, MD, Susumu Sogabe, MD, PhD, Kazuaki Nakanishi MD, PhD, Ken Furuya, MD, PhD, Kanji Kato, MD, PhD, and Hideki Kawamura, MD, PhD for their help with the data collection and useful discussions.

Funding

This work was supported by a Grant-in-Aid for Young Scientists, Japan Society for the Promotion of Science [Grant numbers 18K16294].

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan

    Nobuki Ichikawa, Shigenori Homma, Tadashi Yoshida, Futoshi Kawamata & Akinobu Taketomi

  2. Department of Surgical Pathology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, 060-8638, Japan

    Tomoko Mitsuhashi

  3. Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, 060-8638, Japan

    Hiroaki Iijima

  4. Department of Surgery, Kushiro Rosai Hospital, Japan Labour Health and Welfare Organization, 13-23 Nakazono-cho, Kushiro, Hokkaido, 085-8533, Japan

    Kazuhiro Ogasawara

  5. Department of Surgery, Hokkaido Hospital, Japan Community Healthcare Organization, Nakanoshima 1-8-3-18, Toyohira-ku, Sapporo, 062-8618, Japan

    Keizo Kazui

  6. Department of Surgery, Iwamizawa Municipal Hospital, West 7-2, 9 jou, Iwamizawa, 068-8555, Japan

    You Kamiizumi

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  1. Nobuki Ichikawa
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All authors contributed substantially to the paper’s conception and design; the acquisition, analysis, and interpretation of data; the process of drafting and revision; and final approval of the version to be published.

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Correspondence to Shigenori Homma.

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Ichikawa, N., Homma, S., Yoshida, T. et al. An increase in the peripheral lymphocyte-to-monocyte ratio after primary site resection is associated with a prolonged survival in unresectable colorectal carcinoma. Surg Today 50, 604–614 (2020). https://doi.org/10.1007/s00595-019-01927-1

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