Results from a retrospective study showed that the monocyte-to-lymphocyte ratio (MLR) was an independent predictor of overall survival (OS) in patients with advanced gallbladder cancer who were treated with chemotherapy. The findings from this study were published online in Cancer Epidemiology, Biomarkers & Prevention.

Easily obtainable biomarkers of inflammation include the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the MLR. Other studies have demonstrated an association between NLR/PLR and prognosis in biliary tract cancer, including gallbladder cancer. However, most of the studies performed in gallbladder cancer alone focused on patients with surgically-resected disease. Furthermore, to the authors’ knowledge, no previous studies have evaluated the potential prognostic significance of MLR in gallbladder cancer or other biliary tract cancers.

This study included 178 patients with advanced, unresectable gallbladder cancer who had received at least 2 cycles of systemic chemotherapy at the Seoul National University Hospital, South Korea, between January 2005 and December 2016.

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Baseline data on absolute counts of monocytes, neutrophils, platelets, and lymphocytes were used to determine MLR, NLR, and PLR. Optimal cutoff values of MLR, NLR, and PLR — separating groups of patients with lower and higher ratios — were determined to be 0.24, 2, and 108, respectively.

With respect to patient characteristics, significantly higher proportions of men were observed in groups with high NLR (58.5% vs 37.2%, P =.024) and high MLR (60.0% vs 24.2%, P <.001). Poor performance status tended to be more likely in patients with a high NLR, but no association between patient performance status and either PLR or MLR was observed.  

On multivariate analysis, CA 19-9 stage of higher than 200U/mL (hazard ratio [HR], 1.410; 95% CI, 1.042-1.907; P =.026), higher TNM stage (HR, 1.713; 95% CI, 1.178-2.490; P =.005), and high MLR (HR, 2.100; 95% CI, 1.397-3.157; P <.001) were shown to be independent predictors for poor PFS. In addition, both high MLR (HR, 2.533; 95% CI, 1.664-3.856; P <.001) and high PLR (HR, 1.696; 95% CI, 1.091-2.635; P =.019), as well as aged older than 65 years (HR, 1.506; 95% CI, 1.103-2.056; P =.010), and CA 19-9 of higher than 200 U/mL (HR, 1.680; 95% CI, 1.225-2.305; P =.001), but not high NLR, were found to be independent predictors of poor OS on multivariate analysis.

Although the authors wrote that “the precise mechanism by which high MLR indicates poor outcome remains unclear,” they concluded that “if these results are validated, MLR can be used as a valuable biomarker for prognosis prediction in gallbladder cancer.”


  1. Choi YHLee JWLee SH, et al. A high monocyte-to-lymphocyte ratio predicts poor prognosis in patients with advanced gallbladder cancer receiving chemotherapy [published March 6, 2019]. Cancer Epidemiol Biomarkers Prev. doi: 10.1158/1055-9965.EPI-18-1066