Prognostic Role of the Lymphocyte-to-Monocyte Ratio for Clinical Outcomes of Patients With Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma Treated by Sorafenib

Jonghwa Ahn; Eyun Song; Won Gu Kim; Tae Yong Kim; Won Bae Kim; Young Kee Shong; Min Ji Jeon


Clin Endocrinol. 2020;91(1):71-76. 

In This Article

Abstract and Introduction


Objectives: The lymphocyte-to-monocyte ratio (LMR) reflects the status of tumour-infiltrating immune cells and host immunity. The LMR has been reported as a prognostic marker in various cancers. The present study evaluated the role of the LMR as a prognostic marker in patients with progressive radioiodine-refractory (RAIR) differentiated thyroid carcinoma (DTC).

Design: Retrospective cohort study.

Patients: Forty patients with progressive RAIR DTC who were treated by sorafenib with available baseline complete blood cell count data.

Measurements: We assessed the response rate, progression-free survival (PFS) and overall survival (OS).

Results: The patients were divided into low and high LMR groups based on their baseline LMRs (<4, n = 22, 55% and ≥4, n = 18, 45%, respectively). There were no significant differences in baseline characteristics between the groups. The OS curves differed significantly based on the LMR. The median OS of the low LMR group was 24.3 months and that of the high LMR group was not reached until the end of observation period (P = .015). The PFS curves and median PFS also differed significantly based on the LMR values (P = .019). In multivariate analysis, low LMR was an independent risk factor for all-cause mortality in patients with progressive RAIR DTC (hazard ratio, 2.64; 95% confidence interval: 1.04–6.72, P = .041).

Conclusion: A low LMR was associated with poor response rate, PFS and OS in patients with progressive RAIR DTC treated with sorafenib. Thus, LMR could be a simple prognostic biomarker in patients with progressive RAIR DTC.


Differentiated thyroid carcinoma (DTC), including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma or poorly differentiated carcinoma, has generally good prognoses for the treatment despite being RAI-avid metastatic disease.[1] However, progressive radioiodine-refractory (RAIR) differentiated carcinoma is related to poor survival outcomes, with a reported 10-year survival rate of 10%.[2] The tyrosine kinase inhibitors (TKIs) sorafenib and lenvatinib have been used for systemic therapy to treat progressive RAIR DTC.[3,4]

The thyroid is a highly immune-related organ. Autoimmune thyroiditis showing chronic lymphocytic thyroiditis is the most common autoimmune inflammation in humans. Approximately 30% of DTC patients have evidence of autoimmune thyroiditis, and it is associated with favourable outcomes in DTCs.[5–7] However, tumour-associated macrophages (TAMs) are associated with de-differentiation and poor prognosis in thyroid cancer.[8–10] These suggested tumour-related immune cells and microenvironments are important in the pathogenesis of thyroid cancer.

The lymphocyte-to-monocyte ratio (LMR) has been reported to reflect host immunity in various malignancies.[11–14] Peripheral lymphocytes represent tumour-related lymphocytes, while peripheral monocytes represent TAMs. Therefore, low and high LMRs indicate weak and strong immune responses against tumours, respectively.[3] In a previous study, a low LMR was related to poor prognosis in patients with anaplastic thyroid carcinoma (ATC).[11] However, to our knowledge, no clinical studies have assessed the association between the LMR and DTC. The present analysis included patients with progressive RAIR DTC treated with sorafenib who were candidates for immune-based therapies. The present study aimed to evaluate the role of the LMR as a prognostic marker in progressive RAIR DTC.