Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2019; 25(33): 4970-4984
Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4970
Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer
Xian-Qiang Chen, Chao-Rong Xue, Ping Hou, Bing-Qiang Lin, Jun-Rong Zhang
Xian-Qiang Chen, Chao-Rong Xue, Bing-Qiang Lin, Jun-Rong Zhang, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Ping Hou, Immunotherapy Institute, Fujian Medical University, Fuzhou 350122, Fujian Province, China
Author contributions: Chen XQ and Xue CR contributed equally to this work; Zhang JR, Hou P, and Chen XQ conceived the study, analyzed the data, and drafted the manuscript; Lin BQ helped revise the manuscript critically for important intellectual content; Xue CR helped collect the data and design the study.
Supported by Qihang Project of Fujian Medical University, No. 2017XQ1050.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Fujian Medical University Union Hospital.
Conflict-of-interest statement: All authors read and approved the final manuscript and declared no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: All the study design and drafting comply with the guidelines of the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jun-Rong Zhang, MD, Attending Doctor, Chief Doctor, Surgeon, Surgical Oncologist, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29, Xin Quan Road, Fuzhou 350001, Fujian Province, China.
Telephone: +86-13705955083
Received: April 29, 2019
Peer-review started: April 29, 2019
First decision: May 30, 2019
Revised: June 9, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019

Obstructive colorectal cancer (OCC) is always accompanied by severe complications, and the optimal strategy for patients with OCC remains undetermined. Different from emergency surgery (ES), self-expandable metal stents (SEMS) as a bridge to surgery (BTS), could increase the likelihood of primary anastomosis. However, the stent failure and related complications might give rise to a high recurrence rate. Few studies have focused on the indications for either method, and the relationship between preoperative inflammation indexes and the prognosis of OCC is still underestimated.


To explore the indications for ES and BTS in OCCs based on preoperative inflammation indexes.


One hundred and twenty-eight patients who underwent ES or BTS from 2008 to 2015 were enrolled. Receiver operating characteristic (ROC) curve analysis was used to define the optimal preoperative inflammation index and its cutoff point. Kaplan–Meier analyses and Cox proportional hazards models were applied to assess the association between the preoperative inflammation indexes and the survival outcomes [overall survival (OS) and disease-free survival (DFS)]. Stratification analysis was performed to identify the subgroups that would benefit from ES or BTS.


OS and DFS were comparable between the ES and BTS groups (P > 0.05). ROC curve analysis showed derived neutrophil-to-lymphocyte ratio (dNLR) as the optimal biomarker for the prediction of DFS in ES (P < 0.05). Lymphocyte-to-monocyte ratio (LMR) was recommended for BTS with regard to OS and DFS (P < 0.05). dNLR was related to stoma construction (P = 0.001), pneumonia (P = 0.054), and DFS (P = 0.009) in ES. LMR was closely related to lymph node invasion (LVI) (P = 0.009), OS (P = 0.020), and DFS (P = 0.046) in the BTS group. dNLR was an independent risk factor for ES in both OS (P = 0.032) and DFS (P = 0.016). LMR affected OS (P = 0.053) and DFS (P = 0.052) in the BTS group. LMR could differentiate the OS between the ES and BTS groups (P < 0.05).


Preoperative dNLR and LMR could predict OS and DFS in patients undergoing ES and BTS, respectively. For OCC, as the potential benefit group, patients with a low LMR might be preferred for BTS via SEMS insertion.

Keywords: Inflammation indexes, Emergency surgery, Self-expanding metal stent insertion as a bridge to surgery, Obstructive colorectal cancers

Core tip: As a supplement to recent guidelines, this manuscript demonstrates that lymphocyte-to-monocyte ratio could effectively differentiates the survival outcome between self-expanding metal stenting and emergency surgery in patients with obstructive colon cancer. Self-expanding metal stents might be preferred to the “potential benefit group” that with a low preoperative lymphocyte-to-monocyte ratio (<1.67).