Prognostic value of preoperative lymphocyte-to-monocyte ratio in oral cancer patients and establishment of a dynamic nomogram.

OBJECTIVE To assess the association of preoperative lymphocyte-to-monocyte ratio (LMR) and overall survival (OS) in oral cancer patients and develop a dynamic nomogram for individualized survival prediction. METHOD The prognostic value of LMR was evaluated in a large-scale cohort with 651 postoperative oral cancer patients between January 2010 and December 2017. Propensity score-matched (PSM) analysis and inverse probability of treatment weighting (IPTW) analysis were performed to further verify the prognostic value of LMR. A dynamic nomogram was then developed based on the LMR and clinicopathological features, and its predictive performance and clinical utility were evaluated. RESULTS A high LMR was significantly associated with better OS of oral cancer patients (HR=0.65; 95%CI=0.44-0.98). The similar association was also observed in the PSM and IPTW analyses. Moreover, compared to TNM staging system, the dynamic nomogram based on the LMR exhibited more excellent predictive performance (0.72 vs. 0.64, p< 0.001), with calibration curves (1000 bootstrap resamples) suggesting good match between the actual and predicted probabilities. Decision curve analyses (DCAs) showed a more significant positive net benefit in the practical ranges of threshold probabilities using the dynamic nomogram. CONCLUSION Preoperative LMR may serve as an easily accessible and non-invasive prognostic biomarker for predicting the prognosis of oral cancer patients. A dynamic nomogram based on the LMR may show more convenience in survival prediction for patients with oral cancer. Further future studies are warranted to confirm our findings.