Additional diagnostic value of the monocyte to red blood cell count ratio and the product of lymphocyte count and albumin concentration in lung cancer management

Chen,Xin-Xin; Zhao,Si-Ting; Yang,Xian-Miao; He,Shan-Chuan; Qian,Fen-Hong

doi:10.3892/ol.2023.13721

Additional diagnostic value of the monocyte to red blood cell count ratio and the product of lymphocyte count and albumin concentration in lung cancer management

Authors:
- Xin-Xin Chen
- Si-Ting Zhao
- Xian-Miao Yang
- Shan-Chuan He
- Fen-Hong Qian
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Affiliations: Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, P.R. China
Published online on: February 15, 2023 https://doi.org/10.3892/ol.2023.13721
Article Number: 135
Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to evaluate the potential of the monocyte to red blood cell count ratio (MRR), the neutrophil to red blood cell count ratio (NRR), the lymphocyte to red blood cell count ratio (LRR) and the product of lymphocyte count and albumin concentration (LA) for the diagnosis of lung cancer. The cases of 216 patients with newly diagnosed lung cancer and 184 healthy volunteers were retrospectively analysed. The MRR and NRR were found to be higher in patients with lung cancer compared with those in healthy controls, while the LRR and LA were lower. The receiver operating characteristic curve analysis revealed that of the four markers, the MRR and LA yielded a higher area under the curve (AUC) (MRR: AUC, 0.810; 95% CI, 0.768‑0.847; and LA: AUC, 0.721; 95% CI, 0.674‑0.764). The combination of MRR, LA, carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen 21‑1 (CYFRA21‑1) achieved the highest diagnostic value when compared with other single or combined markers (AUC, 0.882; 95% CI, 0.846‑0.912; sensitivity, 81.9%; specificity, 81.0%). As the disease progressed, the MRR tended to increase, while LA exhibited a decreasing trend. Binary logistic regression analysis revealed an increase in the MRR, as well as in CEA and CYFRA21‑1 concentrations, and a decrease in the LA, which could all be possible risk factors for lung cancer. Differences in the MRR and LA between patients with early stage (IA‑IIIA) lung cancer and healthy controls were observed. Further analysis revealed that the MRR also exhibited the potential to detect early stage (IA‑IIIA) lung cancer in the model. The present findings demonstrated that the MRR and LA may be used as auxiliary biomarkers for the diagnosis of lung cancer and could partly indicate disease progression.

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1	Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021. View Article : Google Scholar : PubMed/NCBI
2	Xia C, Dong X, Li H, Cao M, Sun D, He S, Yang F, Yan X, Zhang S, Li N and Chen W: Cancer statistics in China and United States, 2022: Profiles, trends, and determinants. Chin Med J (Engl). 135:584–590. 2022. View Article : Google Scholar : PubMed/NCBI
3	Jonas DE, Reuland DS, Reddy SM, Nagle M, Clark SD, Weber RP, Enyioha C, Malo TL, Brenner AT, Armstrong C, et al: Screening for lung cancer with low-dose computed tomography: Updated evidence report and systematic review for the US preventive services task force. JAMA. 325:971–987. 2021. View Article : Google Scholar : PubMed/NCBI
4	Grivennikov SI, Greten FR and Karin M: Immunity, inflammation, and cancer. Cell. 140:883–899. 2010. View Article : Google Scholar : PubMed/NCBI
5	Chen W, Xin S and Xu B: Value Research of NLR, PLR, and RDW in prognostic assessment of patients with colorectal cancer. J Healthc Eng. 2022:79714152022. View Article : Google Scholar : PubMed/NCBI
6	Mandaliya H, Jones M, Oldmeadow C and Nordman II: Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): Neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI). Transl Lung Cancer Res. 8:886–894. 2019. View Article : Google Scholar : PubMed/NCBI
7	Garrett C, Becker TM, Lynch D, Po J, Xuan W, Scott KF and de Souza P: Comparison of neutrophil to lymphocyte ratio and prognostic nutritional index with other clinical and molecular biomarkers for prediction of glioblastoma multiforme outcome. PLoS One. 16:e02526142021. View Article : Google Scholar : PubMed/NCBI
8	Jakubowska K, Koda M, Grudzińska M, Kańczuga-Koda L and Famulski W: Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients. World J Gastroenterol. 26:4639–4655. 2020. View Article : Google Scholar : PubMed/NCBI
9	Fang T, Wang Y, Yin X, Zhai Z, Zhang Y, Yang Y, You Q, Li Z, Ma Y, Li C, et al: Diagnostic Sensitivity of NLR and PLR in early diagnosis of gastric cancer. J Immunol Res. 2020:91460422020. View Article : Google Scholar : PubMed/NCBI
10	Baracos VE, Martin L, Korc M, Guttridge DC and Fearon KCH: Cancer-associated cachexia. Nat Rev Dis Primers. 4:171052018. View Article : Google Scholar : PubMed/NCBI
11	Zhang Z, Pereira SL, Luo M and Matheson EM: Evaluation of blood biomarkers associated with risk of malnutrition in older adults: A systematic review and meta-analysis. Nutrients. 9:8292017. View Article : Google Scholar : PubMed/NCBI
12	Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, Neeser O, Huber A, Stanga Z, Mueller B and Schuetz P: Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: A prospective study. Am J Med. 133:713–722.e7. 2020. View Article : Google Scholar : PubMed/NCBI
13	Xie H, Wei L, Tang S and Gan J: Prognostic value of pretreatment albumin-to-alkaline phosphatase ratio in cancer: A meta-analysis. Biomed Res Int. 2020:66610972020. View Article : Google Scholar : PubMed/NCBI
14	Yang JR, Xu JY, Chen GC, Yu N, Yang J, Zeng DX, Gu MJ, Li DP, Zhang YS and Qin LQ: Post-diagnostic C-reactive protein and albumin predict survival in Chinese patients with non-small cell lung cancer: A prospective cohort study. Sci Rep. 9:81432019. View Article : Google Scholar : PubMed/NCBI
15	Wang Y, Wang H, Yin W, Lin Y, Zhou L, Sheng X, Xu Y, Sha R and Lu J: Novel lymphocyte to red blood cell ratio (LRR), neutrophil to red blood cell ratio (NRR), monocyte to red blood cell ratio (MRR) as predictive and prognostic biomarkers for locally advanced breast cancer. Gland Surg. 8:627–635. 2019. View Article : Google Scholar : PubMed/NCBI
16	Yamamoto T, Kawada K, Hida K, Matsusue R, Itatani Y, Mizuno R, Yamaguchi T, Ikai I and Sakai Y: Combination of lymphocyte count and albumin concentration as a new prognostic biomarker for rectal cancer. Sci Rep. 11:50272021. View Article : Google Scholar : PubMed/NCBI
17	Detterbeck FC, Boffa DJ, Kim AW and Tanoue LT: The eighth edition lung cancer stage classification. Chest. 151:193–203. 2017. View Article : Google Scholar : PubMed/NCBI
18	Lang-Lazdunski L: Surgery for nonsmall cell lung cancer. Eur Respir Rev. 22:382–404. 2013. View Article : Google Scholar : PubMed/NCBI
19	Bograd AJ and Vallières E: Surgery as a component of multimodality care for known stage IIIA-N2 non-small cell lung cancer. Semin Respir Crit Care Med. 41:346–353. 2020. View Article : Google Scholar : PubMed/NCBI
20	Wakeam E, Acuna SA, Leighl NB, Giuliani ME, Finlayson SRG, Varghese TK and Darling GE: Surgery versus chemotherapy and radiotherapy for early and locally advanced small cell lung cancer: A propensity-matched analysis of survival. Lung Cancer. 109:78–88. 2017. View Article : Google Scholar : PubMed/NCBI
21	Zhang ZH, Han YW, Liang H and Wang LM: Prognostic value of serum CYFRA21-1 and CEA for non-small-cell lung cancer. Cancer Med. 4:1633–1638. 2015. View Article : Google Scholar : PubMed/NCBI
22	Song WA, Liu X, Tian XD, Wang W, Liang CY, Zhang T, Guo JT, Peng YH and Zhou NK: Utility of squamous cell carcinoma antigen, carcinoembryonic antigen, Cyfra 21-1 and neuron specific enolase in lung cancer diagnosis: A prospective study from China. Chin Med J (Engl). 124:3244–3248. 2011.PubMed/NCBI
23	Giannakeas V, Kotsopoulos J, Cheung MC, Rosella L, Brooks JD, Lipscombe L, Akbari MR, Austin PC and Narod SA: Analysis of platelet count and new cancer diagnosis over a 10-year period. JAMA Netw Open. 5:e21416332022. View Article : Google Scholar : PubMed/NCBI
24	Tan Q, Liu S, Liang C, Han X and Shi Y: Pretreatment hematological markers predict clinical outcome in cancer patients receiving immune checkpoint inhibitors: A meta-analysis. Thorac Cancer. 9:1220–1230. 2018. View Article : Google Scholar : PubMed/NCBI
25	Chan SWS, Smith E, Aggarwal R, Balaratnam K, Chen R, Hueniken K, Fazelzad R, Weiss J, Jiang S, Shepherd FA, et al: Systemic inflammatory markers of survival in epidermal growth factor-mutated non-small-cell lung cancer: Single-institution analysis, systematic review, and meta-analysis. Clin Lung Cancer. 22:390–407. 2021. View Article : Google Scholar : PubMed/NCBI
26	Peng F, Hu D, Lin X, Chen G, Liang B, Li C, Chen Y, Cui Z, Zhang H, Lin J, et al: The monocyte to red blood cell count ratio is a strong predictor of postoperative survival in colorectal cancer patients: The Fujian prospective investigation of cancer (FIESTA) study. J Cancer. 8:967–975. 2017. View Article : Google Scholar : PubMed/NCBI
27	Robinson A, Han CZ, Glass CK and Pollard JW: Monocyte regulation in homeostasis and malignancy. Trends Immunol. 42:104–119. 2021. View Article : Google Scholar : PubMed/NCBI
28	Wesselius LJ, Wheaton DL, Manahan-Wahl LJ, Sherard SL, Taylor SA and Abdou NA: Lymphocyte subsets in lung cancer. Chest. 91:725–729. 1987. View Article : Google Scholar : PubMed/NCBI
29	Wang YY, Zhou N, Liu HS, Gong XL, Zhu R, Li XY, Sun Z, Zong XH, Li NN, Meng CT, et al: Circulating activated lymphocyte subsets as potential blood biomarkers of cancer progression. Cancer Med. 9:5086–5094. 2020. View Article : Google Scholar : PubMed/NCBI
30	Yang Z, Zheng Y, Wu Z, Wen Y, Wang G, Chen S, Tan F, Li J, Wu S, Dai M, et al: Association between pre-diagnostic serum albumin and cancer risk: Results from a prospective population-based study. Cancer Med. 10:4054–4065. 2021. View Article : Google Scholar : PubMed/NCBI
31	Fiala O, Pesek M, Finek J, Racek J, Minarik M, Benesova L, Bortlicek Z, Sorejs O, Kucera R and Topolcan O: Serum albumin is a strong predictor of survival in patients with advanced-stage non-small cell lung cancer treated with erlotinib. Neoplasma. 63:471–476. 2016. View Article : Google Scholar : PubMed/NCBI
32	White JV, Guenter P, Jensen G, Malone A and Schofield M; Academy of Nutrition and Dietetics Malnutrition Work Group and A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors, : Consensus statement of the Academy of Nutrition and Dietetics/American society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 112:730–738. 2012. View Article : Google Scholar : PubMed/NCBI
33	Nagai M, Noguchi R, Takahashi D, Morikawa T, Koshida K, Komiyama S, Ishihara N, Yamada T, Kawamura YI, Muroi K, et al: Fasting-Refeeding impacts immune cell dynamics and mucosal immune responses. Cell. 178:1072–1087.e14. 2019. View Article : Google Scholar : PubMed/NCBI
34	Iyer SS, Chatraw JH, Tan WG, Wherry EJ, Becker TC, Ahmed R and Kapasi ZF: Protein energy malnutrition impairs homeostatic proliferation of memory CD8 T cells. J Immunol. 188:77–84. 2012. View Article : Google Scholar : PubMed/NCBI