MIMIC 研究：单核细胞/淋巴细胞比值和乳酸脱氢酶水平在转移性结直肠癌中的预后作用和截断值定义。
The MIMIC Study: Prognostic Role and Cutoff Definition of Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase Levels in Metastatic Colorectal Cancer.
机构信息
Department of Medicine, University of Udine, Udine, Italy.
Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy.
出版信息
Oncologist. 2020 Aug;25(8):661-668. doi: 10.1634/theoncologist.2019-0780. Epub 2020 Mar 23.
BACKGROUND
Monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels are circulating biomarkers that provide information about tumor-related inflammation and immune suppression. This study aimed to evaluate the prognostic role of MLR and LDH in metastatic colorectal cancer (mCRC).
MATERIAL AND METHODS
This multicentric study analyzed a consecutive cohort of 528 patients with mCRC treated in 2009-2017. The whole population was randomly divided in training and validation cohort. The first was used to identify a threshold for MLR and to create the prognostic model with MLR and MLR-LDH combined (group 1: MLR-LDH low; group 2: MLR or LDH high; group 3: MLR-LDH high). The second cohort was used to validate the model.
RESULTS
At the median follow-up of 55 months, median overall survival (OS) was 22 months. By multivariate analysis, high MLR >0.49 (hazard ratio [HR], 2.37; 95% confidence interval [C.I.], 1.39-4.04), high LDH (HR, 1.73; 95% C.I., 1.03-2.90) in the first model, group 2 (HR, 2.74; 95% C.I.; 1.62-4.66), and group 3 (HR, 3.73; 95% C.I., 1.94-7.18) in the combined model, had a worse prognosis in terms of OS. These data were confirmed both in the validation set and then in the whole cohort.
CONCLUSION
MLR and LDH are circulating cost-effective biomarkers, readily available in clinical practice, that can be useful for predicting the prognosis of patients with mCRC.
IMPLICATIONS FOR PRACTICE
High monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels could be a sign of a tumor's recruitment of suppressive and inflammatory cells worsening prognosis of different types of cancer, including colorectal cancer (CRC). Currently, no data are available for metastatic CRC regarding a cutoff definition for MLR or the prognostic impact of MLR and MLR-LDH combined. The present study showed in the training cohort and confirmed in the validation and whole cohort that MLR is a reliable and independent laboratory biomarker, which is easy to use, to predict clinical outcomes in patients with mCRC. Moreover, MLR and composite MLR-LDH could potentially result in an incremental improvement in the prognostic value of these biomarkers, being used as stratification tools for patients with mCRC.
背景
单核细胞与淋巴细胞比值（MLR）和乳酸脱氢酶（LDH）水平是循环生物标志物，可提供有关肿瘤相关炎症和免疫抑制的信息。本研究旨在评估 MLR 和 LDH 在转移性结直肠癌（mCRC）中的预后作用。
材料和方法
这项多中心研究分析了 2009-2017 年期间治疗的 528 例 mCRC 连续队列患者。将整个人群随机分为训练和验证队列。第一部分用于确定 MLR 的阈值，并创建 MLR 和 MLR-LDH 联合的预后模型（组 1：MLR-LDH 低；组 2：MLR 或 LDH 高；组 3：MLR-LDH 高）。第二部分用于验证模型。
结果
在中位随访 55 个月时，中位总生存期（OS）为 22 个月。通过多变量分析，高 MLR>0.49（风险比[HR]，2.37；95%置信区间[CI]，1.39-4.04），高 LDH（HR，1.73；95%CI，1.03-2.90）在第一模型中，组 2（HR，2.74；95%CI；1.62-4.66）和组 3（HR，3.73；95%CI，1.94-7.18）在联合模型中，OS 预后更差。这些数据在验证集和整个队列中均得到证实。
结论
MLR 和 LDH 是循环的具有成本效益的生物标志物，在临床实践中易于获得，可用于预测 mCRC 患者的预后。
实践意义
高单核细胞与淋巴细胞比值（MLR）和乳酸脱氢酶（LDH）水平可能是肿瘤招募抑制性和炎症细胞的标志，从而恶化包括结直肠癌（CRC）在内的多种癌症的预后。目前，尚无转移性 CRC 关于 MLR 截断定义或 MLR 和 MLR-LDH 联合预后影响的数据。本研究在训练队列中显示，在验证队列和整个队列中得到证实，MLR 是一种可靠且独立的实验室生物标志物，易于使用，可预测 mCRC 患者的临床结局。此外，MLR 和复合 MLR-LDH 可能会使这些生物标志物的预后价值得到进一步提高，并作为 mCRC 患者的分层工具。
Zotero 插件