Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer

Table 1 Comparison of clinicopathological characteristics between emergency surgery and bridge to surgery groups

Characteristic	ES group (n = 90)	BTS group (n = 38)	P-value
Age (yr)	61.58 ± 14.84	63.21 ± 13.55	0.561
Female/Male, (%)	31 (34.40)/59 (65.60)	15 (39.50)/23 (60.50)	0.588
Size, (cm)	5.76 ± 2.12	6.88 ± 2.68	0.015
BMI, (kg/m2)	21.76 ± 2.42	22.20 ± 3.20	0.411
Cross score, (%)			0.001
0	21 (23.60)	21 (55.30)
1	40 (44.90)	16 (42.10)
2	17 (19.10)	1 (2.60)
3	10 (11.20)	0 (0.00)
4	1 (0.80)	0 (0.00)
ASH (+)/(-), (%)	17 (18.90)/73 (81.10)	10 (26.30)/28 (73.70)	0.347
Comorbidities (+)/(-), (%)	37 (41.10)/53 (58.90)	21 (55.30)/17 (44.70)	0.142
ASA grade, (%)			0.299
I	2 (2.20)	3 (7.90)
II	63 (70.00)	28 (73.70)
≥ III	25 (27.80)	7 (18.40)
Location, (%)			0.005
Right-side colon	13 (14.40)	1 (2.60)
Transverse colon	30 (33.30)	5 (13.20)
Left-side colon	37 (41.10)	28 (73.70)
Rectum	10 (11.10)	4 (10.50)
pTNM stage, (%)			0.186
I	4 (4.40)	0 (0.00)
II	23 (25.60)	9 (23.70)
III	44 (48.90)	25 (65.80)
IV	19 (21.10)	4 (10.50)
T stage, (%)			0.186
T1	4 (4.40)	0 (0.00)
T2	23 (25.60)	9 (23.70)
T3	44 (48.90)	25 (65.80)
T4	19 (21.10)	4 (10.50)
N stage, (%)			0.471
N0	31 (34.40)	9 (23.70)
N1	35 (38.90)	18 (47.40)
N2	24 (26.70)	11 (28.90)
M stage, (%)			0.292
M0	71 (78.9)	33 (86.8)
M1	19 (21.1)	5 (13.2)
Histological features, (%)			0.308
Well differentiated	3 (2.30)	0 (0.00)
Moderately differentiated	61 (67.80)	30 (78.90)
Poorly differentiated	26 (28.90)	8 (21.10)
LVI (+)/(-), (%)	15 (16.70)/75 (83.30)	14(36.80)/24(63.20)	0.013
WBC, (10^9)	8.99 ± 5.10	7.57 ± 2.61	0.042
NLR, (ratio)	7.11 ± 6.72	4.88 ± 3.02	0.012
dNLR, (ratio)	1.66 ± 0.41	1.67 ± 0.27	0.756
PLR, (ratio)	245.61 ± 144.17	229.98 ± 122.38	0.562
LMR, (ratio)	2.84 ± 2.43	2.34 ± 1.19	0.127
SII, (ratio)	1969.03 ± 2316.10	1235.74 ± 849.53	0.011
WBC-pre, (10^9)	9.18 ± 5.13	8.56 ± 3.44	0.434
NLR-pre, (ratio)	7.62 ± 6.97	6.05 ± 3.03	0.084
dNLR-pre, (ratio)	1.65 ± 0.41	1.68 ± 0.45	0.652
PLR-pre, (ratio)	263.98 ± 161.96	270.89 ± 171.35	0.830
LMR-pre, (ratio)	2.77 ± 2.32	2.38 ± 1.66	0.354
SII-pre, (ratio)	2186.46 ± 2474.96	1712.60 ± 1157.32	0.149
CEA, (ng/mL)	30.19 ± 120.54	17.88 ± 27.47	0.541
Chemotherapy (+)/(-), (%)	62 (68.90)/28 (31.10)	20 (52.60)/18 (47.40)	0.080

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; ASH: Abdominal surgery history; WBC: White blood cells; dNLR: Derived neutrophil–to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SII: Systemic immune inflammation index; LMR: Lymphocyte-to-monocyte ratio; Cross: Colorectal obstruction scoring system; LVI: Lymphovascular invasion. P < 0.05 was considered statistically significant.

Table 2 Comparison of short-term and long-term outcomes between emergency surgery and bridge to surgery groups

Characteristic	ES group (n = 90)	BTS group (n = 38)	P-value
Surgical time, (min)	217.89 ± 60.69	204.64 ± 66.13	0.275
Blood loss, (mL)	177.30 ± 134.37	133.68 ± 95.76	0.072
Number of LNs	19.51 ± 9.47	21.45 ± 8.29	0.276
Time to flatus, (d)	3.88 ± 1.65	3.61 ± 1.15	0.359
Time to semi-fluid, (d)	8.62 ± 3.22	8.64 ± 3.96	0.738
Total hospital-stay, (d)	22.17 ± 12.48	22.34 ± 7.78	0.936
Stoma construction, n (%)	20 (22.20)	8 (21.10)	0.884
CD classification system, n (%)			0.547
Grade I	0 (0.00)	2 (2.20)
Grade II	44 (48.90)	16 (42.10)
Grade III	13 (14.40)	5 (13.20)
Grade IV	9 (10.00)	2 (5.30)
Grade V	1 (2.60)	1 (1.10)
Pneumonia, n (%)	18 (20.00)	8 (21.10)	0.892
Incision infection, n (%)	16 (17.80)	5 (13.20)	0.519
ICU intervention, n (%)	8 (8.90)	1 (2.60)	0.192
Leakage, n (%)	3 (3.30)	1 (2.60)	0.658
Sepsis, n (%)	3 (3.30)	1 (2.60)	0.658
SAE, n (%)	23 (25.60)	8 (21.10)	0.587
30 d-mortality, n (%)	1 (1.10)	1 (2.60)	0.507
36-OS time, (mo)	30.10 ± 9.64	29.41 ± 11.33	0.732
36-DFS time, (mo)	27.59 ± 12.19	27.48 ± 12.17	0.969

LN: Lymph node; SEMS: Self-expanding metal stents; BTS: Bridge to surgery; SAE: Severe adverse effects. P < 0.05 was considered statistically significant.

Table 3 Receiver operating characteristic curve analysis of long-term survival of emergency surgery and bridge to surgery groups

Group	Characteristic	3-year OS			3-year DFS
		Cutoff point	AUC	95%CI	Cutoff point	AUC	95%CI
ES	NLR	19.3	0.582	0.446-0.718	19.3	0.565	0.407-0.723
	dNLR	2.02	0.679	0.551-0.808	1.57	0.696	0.554-0.837
	PLR	155	0.550	0.414-0.686	317	0.549	0.392-0.707
	SII	3645	0.587	0.454-0.721	3645	0.564	0.403-0.726
	CEA	6.7	0.591	0.458-0.724	11.2	0.604	0.442-0.766
BTS	LMR	1.67	0.611	0.424-0.798	1.67	0.571	0.366-0.776
	CEA	7.6	0.549	0.350-0.747	5.5	0.552	0.348-0.756

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; AUC: Area under the receiver operating characteristic curve; dNLR: Derived neutrophil-to-lymphocyte ratio; PLR: Platelet–to-lymphocyte ratio; SII: Systemic immune inflammation index; LMR: Lymphocyte-to-monocyte ratio; OS: Overall survival; DFS: Disease-free survival; CEA: Carcino-embryonic antigen. P < 0.05 was considered statistically significant.

Table 4 Comparison of clinicopathological features between high-ratio and low-ratio grades in both emergency surgery and bridge to surgery groups

Characteristic	ES group (n = 86)			BTS group (n = 38)
	dNLR ≥ 1.57	dNLR < 1.57	P-value	LMR ≥ 1.67	LMR < 1.67	P-value
Cross score, (%)			0.738			0.378
0	11 (27.5)	10 (21.7)		10 (50.0)	11 (61.1)
1	16 (40.0)	22 (47.8)		10 (50.0)	6 (33.3)
2	8 (20.0)	8 (17.4)		0 (0.0)	1 (5.6)
3	4 (10.0)	6 (13.0)
4	1 (2.5)	0 (0.0)
ASH (+)/(-), (%)	6 (15.0)/34 (85.0)	10 (21.7)/36 (78.3)		4 (20.0)/16 (80.0)	6 (33.3)/12 (66.7)
Comorbidities (+)/(-), (%)	20 (50.0)/20 (50.0)	17 (37.0)/29 (63.0)		9 (45.0)/11 (55.0)	12 (66.7/)/6 (33.3)
ASA grade, (%)			0.320			0.623
I	0 (0.0)	1 (1.6)		1 (5.0)	2 (11.1)
II	13 (56.5)	47 (74.6)		16 (80.0)	12 (66.7)
≥ III	10 (43.5)	15 (23.8)		3 (15.0)	4 (22.2)
Location, (%)			0.007			0.523
Right-side colon	2 (5.0)	11 (23.9)		1 (5.0)	0 (0.00)
Transverse colon	10 (25.0)	19 (41.3)		3 (15.0)	2 (11.1)
Left-side colon	21 (52.5)	13 (28.3)		13 (65.0)	15 (83.3)
Rectum	7 (17.5)	3 (6.5)		3 (15.0)	1 (5.6)
pTNM stage, (%)			0.141			0.592
I	0 (0.0)	4 (8.7)		-	-
II	12 (30.0)	10 (21.7)		4 (20.0)	5 (27.8)
III	17 (42.5)	24 (52.2)		13 (65.0)	12 (66.7)
IV	11 (27.5)	8 (17.4)		3 (15.0)	1 (5.6)
T stage, (%)			0.141			0.592
T1	0 (0.0)	4 (8.7)		-	-
T2	12 (30.0)	10 (21.7)		4 (20.0)	5 (27.8)
T3	17 (42.5)	24 (52.2)		13 (65.0)	12 (66.7)
T4	11 (27.5)	8 (17.4)		3 (15.0)	1 (5.6)
N stage, (%)			0.648			0.009
N0	16 (40.0)	14 (30.4)		4 (20.0)	5 (27.8)
N1	14 (35.0)	19 (41.3)		6 (30.0)	12 (66.7)
N2	10 (25.0)	13 (28.3)		10 (50.0)	1 (5.6)
M stage, (%)			0.260			0.552
M0	29 (72.5)	38 (82.6)		17 (85.0)	16 (88.9)
M1	11 (27.5)	8 (17.4)		3 (15.0)	2 (11.1)
Histological features, (%)			0.605			0.411
Well differentiated	1 (2.5)	2 (4.3)		-	-
Moderately differentiated	30 (75.0)	30 (65.2)		15 (75.0)	15 (83.3)
Poorly differentiated	9 (22.5)	14 (30.4)		5 (25.0)	3 (16.7)
LVI (+)/(-), (%)	9 (22.5)/31 (77.5)	6 (13.0)/40 (87.0)	0.249	10 (50.0)/10 (50.0)	4 (22.2)/14 (77.8)	0.076
Stoma construction, (%)			0.000			0.589
Stoma	17 (42.5)	3 (6.5)		4 (20.0)	4 (22.2)
None	23(57.5)	43 (93.5)		16 (80.0)	14 (77.8)
Pneumonia, (+)/(-), (%)	12 (30.0)/28 (70.0)	6 (13.0)/40 (87.0)	0.054	2 (10.0)/18(90.0)	6 (33.3)/12 (66.7)	0.086
Incision infection, (+)/(-), (%)	8 (20.0)/32 (80.0)	8 (17.4)/38 (82.6)	0.486	2 (10.0)/18 (90.0)	3 (16.7)/15 (83.3)	0.448
ICU intervention, (+)/(-), (%)	5 (12.5)/35 (87.5)	3 (6.5)/43 (93.5)	0.281	1 (5.0)/19 (95.0)	0 (0.0)/18 (100.0)	0.526
Leakage, (+)/(-), (%)	1 (2.5)/39 (97.5)	2 (4.3)/44 (95.7)	0.553	0 (0.0)/20 (100.0)	1 (5.6)/17 (94.4)	0.474
Sepsis, (+)/(-), (%)	1 (2.5)/39 (97.5)	2 (4.3)/44 (95.7)	0.553	0 (0.0)/20 (100.0)	1 (5.6)/17 (94.4)	0.474
SAE, (+)/(-), (%)	10 (25.0)/30 (75.0)	11 (23.9)/35 (76.1)	0.907	5 (25.0)/15 (75.0)	3 (16.7)/15 (83.3)	0.411
30-day mortality, n (%)	1 (2.5)/39 (97.5)	0 (0.0)/46 (100.0)	0.465	1 (5.0)/19 (95.0)	0 (0.0)/18 (100.0)	0.526
36-OS time, (months)	28.05 ± 10.28	31.61 ± 9.16	0.106	25.26 ± 13.88	33.78 ± 5.35	0.020
36-DFS time, (months)	23.10 ± 13.85	31.45 ± 9.35	0.009	22.67 ± 14.02	31.50 ± 8.89	0.046

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; Cross: Colorectal obstruction scoring system; ASH: Abdominal surgery history; dNLR: Derived neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SII: Systemic immune inflammation index; LMR: Lymphocyte-to-monocyte ratio; LVI: Lymphovascular invasion; OS: Overall survival; DFS: Disease-free survival; ICU: Intense care unit; SAE: Severe adverse effects. P < 0.05 was considered statistically significant.

Table 5 Univariate and multivariate analyses of risk factors for survival outcomes in both emergency surgery and bridge to surgery groups

3-year overall survival	ES group (n = 90)				BTS group (n = 38)
	Univariate		Multivariate		Univariate		Multivariate
Characteristic	HR (95%CI)	P-value	HR (95%CI)	P-value	HR (95%CI)	P-value	HR (95%CI)	P-value
CEA (≥ 5 ng/mL vs < 5 ng/mL)	1.48 (0.70-3.11)	0.303			2.53 (0.68-9.35)	0.165
ASA (Grade ≥ III vs Grade < III)	1.50 (0.72-3.11)	0.277			1.64 (0.45-5.96)	0.454
pT stage (pT3-4 vs pT1-2)	1.66 (0.72-3.83)	0.238			4.17 (1.09-15.95)	0.037
pN stage (pN+ vs pN0)	1.05 (0.51-2.19)	0.887			5.02 (0.65-38.66)	0.122
LVI (+) vs LVI (-)	1.30 (0.53-3.15)	0.568			3.78 (1.23-11.64)	0.020	3.52 (1.03-12.02)	0.045
NLR ≥ 19.3 vs NLR < 19.3	2.98 (1.27-6.97)	0.012
dNLR ≥ 1.57 vs dNLR < 1.57	2.40 (1.12-5.13)	0.024	2.34 (1.08-5.07)	0.032
PLR ≥ 155 vs PLR < 155	1.83 (0.70-4.79)	0.217
SII ≥ 3645 vs SII < 3645	1.61 (0.71-3.61)	0.252
LMR ≥ 1.67 vs LMR < 1.67					4.09 (1.12-14.87)	0.033	4.57 (0.98-21.38)	0.053
Chemotherapy (+) vs (-)	0.74 (0.36-1.51)	0.402			1.43 (0.47-4.38)	0.529

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; dNLR: Derived neutrophil-to-lymphocyte ratio; PLR: Platelet–to-lymphocyte ratio; SII: Systemic immune inflammation index; LMR: Lymphocyte-to-monocyte ratio; LVI: Lymphovascular invasion. P < 0.05 was considered significant.

Table 6 Univariate and multivariate analyses of risk factors for oncological outcomes in both emergency surgery and bridge to surgery groups

3-year disease-free survival	ES group (n = 56)				BTS group (n = 32)
	Univariate		Multivariate		Univariate		Multivariate
Characteristic	HR (95%CI)	P-value	HR (95%CI)	P-value	HR (95%CI)	P-value	HR (95%CI)	P-value
CEA (≥ 5 ng/mL vs < 5 ng/mL)	1.71 (0.74-3.95)	0.209			2.67 (0.72-9.90)	0.141
ASA (Grade ≥ III vs Grade < III)	0.890 (0.36-2.23)	0.803			1.49 (0.41-5.43)	0.542
pT stage (pT3-4 vs pT1-2)	2.26 (0.85-6.02)	0.104			2.48 (0.55-11.18)	0.239
pN stage (pN+ vs pN0)	1.48 (0.64-3.43)	0.361			2.48 (0.55-11.18)	0.239
LVI (+) vs LVI (-)	2.92 (1.25-6.81)	0.013			1.97 (0.66-5.88)	0.224
NLR ≥ 19.3 vs NLR < 19.3	2.76 (1.02-7.45)	0.046
dNLR ≥ 1.57 vs dNLR < 1.57	2.85 (1.17-6.95)	0.021	3.02(1.23-7.42)	0.016
PLR ≥ 317 vs PLR < 317	1.55 (0.66-3.67)	0.314
SII ≥ 3645 vs SII < 3645	2.04 (0.86-4.83)	0.104
LMR ≥ 1.67 vs LMR < 1.67					2.54 (0.83-7.80)	0.091	3.11 (1.13-8.54)	0.052
Chemotherapy (+) vs (-)	0.95 (0.41-2.19)	0.896			1.44 (0.47-4.41)	0.523

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; dNLR: Derived neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SII: Systemic immune inflammation index; LMR: Lymphocyte-to-monocyte ratio; LVI: Lymphovascular invasion. Chemotherapy (+), accept chemotherapy lately. Chemotherapy (-), refuse to chemotherapy lately. P < 0.05 was considered significant.

Table 7 Stratification analysis of oncological and survival outcomes between high-ratio and low-ratio grades in both emergency surgery and bridge to surgery groups

Characteristic	3-year OS		3-year DFS
	HR (95%CI)	P-value	HR (95%CI)	P-value
ES (dNLR < 1.57)	Reference	-	Reference	-
BTS (dNLR < 1.57)	0.51 (0.18-1.39)	0.185	0.42 (0.13-1.34)	0.144
ES (dNLR ≥ 1.57)	Reference	-	Reference	-
BTS (dNLR ≥ 1.57)	1.87 (0.79-4.43)	0.155	1.79 (0.77-4.20)	0.178
ES (LMR < 1.67)	Reference	-	Reference	-
BTS (LMR < 1.67)	4.34 (1.27-14.82)	0.019	2.72 (0.97-7.65)	0.058
ES (LMR ≥ 1.67)	Reference	-	Reference	-
BTS (LMR ≥ 1.67)	0.40 (0.18-0.92)	0.031	0.42 (0.17-1.07)	0.068

SEMS: Self-expanding metal stents; BTS: Bridge to surgery; dNLR: Derived neutrophil-to-lymphocyte ratio; OS: Overall survival; DFS: Disease-free survival; LMR: Lymphocyte-to-monocyte ratio. P < 0.05 was considered statistically significant.