Low preoperative lymphocyte-monocyte ratio (LMR) represents a potentially poor prognostic factor in nonmetastatic XXXX .

@entity1 @entity1803 @entity39 @entity5 @entity1358 @entity3
OBJECTIVES: To explore the potential prognostic significance of the lymphocyte-monocyte ratio (LMR) in @entity1 with nonmetastatic @entity1358 ( @entity1358 ), as the LMR has been repeatedly proposed to have a negative effect on @entity1  s survival in various hematological and solid @entity5 . However, findings about LMR  s prognostic significance in @entity1358 have not been reported yet. METHODS AND MATERIALS: We retrospectively evaluated the prognostic significance of the LMR in a cohort comprising 678 @entity1 with nonmetastatic clear cell @entity1358 , who were operated between 2000 and 2010 with curative radical or partial nephrectomy at a single tertiary academic center. Preoperative LMR was calculated 1 day before surgical intervention. @entity1 were categorized using an LMR cutoff of 3.0. Cancer-specific survival (CSS), @entity3 -free survival, and overall survival were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the LMR, multivariate Cox regression models were applied. Additionally, the influence of the LMR on the predictive accuracy of the Leibovich prognosis score was determined using the Harrell concordance index (c-index) and decision curve analysis. RESULTS: Low LMR was statistically significantly associated with older @entity1 (>= 65y), high @entity5 grade (G3+G4), advanced pathologic T category ( @entity1803 +pT4), the presence of histologic @entity5 @entity39 , and male gender (P<0.05). Multivariate analysis identified a low LMR as an independent prognostic factor for @entity1   CSS (hazard ratio = 2.33; 95% CI: 1.10-4.94; P = 0.027). The estimated c-index was 0.83 using the Leibovich prognosis score and 0.86 when the LMR was added. CONCLUSIONS: Regarding CSS of @entity1 with @entity1358 , a decreased LMR represents an independent prognostic factor. Adding the LMR to well-established prognostic models, such as the Leibovich prognosis score, might improve their predictive ability.
