Clinical and prognostic significance of preoperative lymphocyte-monocyte ratio, neutrophil-lymphocyte ratio and neutrophil-monocyte ratio on esophageal squamous cell carcinoma patients

It’s well known that esophageal cancer is one of the most malignant cancer all over the world and only 10–40% esophageal cancer patients will survive for more than 5 years postoperatively (1,2). Meanwhile, China is a high incidence area for esophageal squamous cell carcinoma (ESCC) with the morbidity of 90% (3,4). The 5-year overall survival rate of ESCC patients in stage IIA–III treated by surgical resection alone is from 20.6% to 34.0% (5,6), which is almost the same as the patients administrated with multimodality therapies including surgery, chemotherapy and radiotherapy (7). TNM stage and tumor differentiation were demonstrated as the independent prognostic factor of esophageal cancer in previous reports (8), however, the heterogeneity of prognosis also exists in patients with same stage. Some investigators showed that cancer-related inflammation leads to worse prognosis, and the inflammatory biomarkers play an important role (9). At the same time, the neutrophil-lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) have been reported to be the independent prognostic factor correlated to breast, gastric and lung cancer (10-12) previously, however, few studies have showed the prognostic role of the inflammatory biomarkers in ESCC, especially the role of neutrophil-monocyte ratio (NMR). What’s more, the methods of optimal cut-off value determination in published esophageal cancer studies were various, some were empirical, therefore, we took the more practical and precise method to determine the optimal cut-off value of LMR, NLR and NMR in order to evaluate whether preoperative LMR, NLR and NMR plays a key role in survival of ESCC patients. We present this article in accordance with the STROBE reporting checklist (available at http://dx.doi.org/10.21037/tcr-19-2777)