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Prognostic Impact of Monocyte to Lymphocyte Ratio in Clinical Outcome for Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Masoud Nouri-Vaskeh, Mohammad Mirza-Aghazadeh-Attari, Fariba Pashazadeh, Saber Azami-Aghdash, Hadi Alizadeh, Parnia Pouya, Monireh Halimi, Golamreza Jadideslam, Mohammad Zarei

Background: Lymphocyte to monocyte ratio (LMR) is a surrogate marker of systemic inflammation which is shown to be related to patient’s survival in multiple malignancies. An important implication of this marker potentially is neoplasms in which there is no correlation between prognosis and histopathological staging, or has no reliable chemical markers associated with prognosis. Herein, this meta-analysis aimed to investigate the prognostic role of LMR in the patients with hepatocellular carcinoma (HCC).

Methods: In the current systemic review and meta-analysis, we conducted a systemic search of databases and indexing sources, including Medline (PubMed), EMBASE, Cochrane, Scopus, and ProQuest up to May 2019. We include studies evaluating the prognostic significance of LMR on patients with HCC. Overall survival (OS), disease free survival (DFS) and recurrence free survival (RFS) values were extracted from the studies and analyzed. The pooled hazard ratio with 95% confidence interval explored to identify the prognostic value of LMR in survival of the patients with HCC.

Results: A total of 12 studies with a total sample size of 3750 were included. There was significant heterogeneity among the studies, so subgroup analysis was also performed. Overall analysis regarding OS showed an insignificant relationship between LMR and patient’s prognosis, subgroup based on LMR cut-offs did not yield any significant result, subgroup analysis for RFS founded statistically significant results and LMR was significantly related to DFS.

Conclusion: High LMR was associated with increased DFS and RFS, in return this correlation was not observed for OS.
Hepatocellular Carcinoma; Liver Neoplasm; Lymphocyte to Monocyte Ratio; Survival; Disease-Free Survival

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