Supplementary Material for: The Prognostic Impact of the Lymphocyte-to-Monocyte Ratio in Resected Pancreatic Head Adenocarcinoma

Objective: Although the prognostic significance of systematic inflammation-based scores, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the prognostic nutritional index (PNI), has been explored in pancreatic cancers, few reports have investigated the lymphocyte-to-monocyte ratio (LMR). We aimed to retrospectively investigate the prognostic value of the preoperative LMR in patients with resectable pancreatic head cancer (PHC). Methods: From 2005 to 2016, 165 patients underwent pancreatoduodenectomy for PHC. All samples of peripheral blood were collected within 2 weeks prior to surgery. The best cutoff values of the LMR for predicting survival were determined by using a minimum p value approach (cut-off value: 2.8). The clinicopathological features of LMR n = 25) and ≥2.8 (n = 140) were compared. Results: Patients with LMR ≥2.8 showed significantly lower NLR and PLR, and significantly higher PNI. Levels of CEA and CA19-9 were similar, and the pathological findings were comparable between the groups. The overall survival of patients with LMR ≥2.8 (66.2% at 1 year) was superior to that of patients with LMR p = 0.015). Multivariate analysis identified LMR p = 0.042), lymphatic and venous invasion and positive surgical margin as independent prognostic factors. Conclusions: LMR may carry important prognostic information for patients with resectable PHC. Preoperative LMR may be considered for use in risk stratification for individual patients with PHC.研究目的：尽管中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）及预后营养指数（prognostic nutritional index, PNI）等基于系统性炎症的评分的预后价值已在胰腺癌中得到探索，但针对淋巴细胞与单核细胞比值（lymphocyte-to-monocyte ratio, LMR）的相关研究报道仍较为匮乏。本研究旨在回顾性分析可切除胰头癌（pancreatic head cancer, PHC）患者术前LMR的预后价值。研究方法：2005年至2016年间，共计165名因胰头癌接受胰十二指肠切除术的患者纳入本研究。所有外周血样本均于术前2周内采集。采用最小P值法确定LMR预测患者生存的最佳截断值（截断值为2.8），并据此将患者分为LMR<2.8组（n=25）与LMR≥2.8组（n=140），比较两组的临床病理特征。研究结果：LMR≥2.8组患者的NLR与PLR水平显著更低，PNI水平显著更高。两组患者的癌胚抗原（CEA）与糖链抗原19-9（CA19-9）水平及病理结果均无显著差异。LMR≥2.8组患者的总生存率（1年生存率为66.2%）显著优于LMR<2.8组患者（p=0.015）。多因素分析显示，LMR（p=0.042）、淋巴静脉侵犯及手术切缘阳性为独立预后因素。研究结论：LMR可为可切除胰头癌患者提供重要的预后信息，术前LMR可考虑用于胰头癌患者的个体风险分层。