Shan Chen,1,* Wan-Hua Chang,2,* Jie Zhang,1,* Xiao-Yuan Liu,3,* Ting Gao,1 Xiao-Wei Qi,4 Dong-Yan Cai,1 Yong Mao,1 Ting-Xun Lu1 

1Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China; 2Department of Gastroenterology, Huaian Hospital of Huaian City, Huai’an, Jiangsu Province, People’s Republic of China; 3Department of Clinical Pharmacy, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China; 4Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ting-Xun Lu, Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China, Email lutingxun@163.com

Purpose: This study assessed lymphocyte-to-monocyte ratio (LMR) changes to predict postoperative recurrence in Fusobacterium nucleatum-positive (Fn-positive) CRC patients.
Patients and Methods: Clinical information and paraffin tissue specimens were collected from a retrospective cohort of 332 patients. The abundance of Fn in tumor tissue was measured using a quantitative polymerase chain reaction. We evaluated the prognostic value and diagnostic performance of the dynamic changes of LMR from pre-operative to post-treatment (pr-LMR-po) and the dynamic alterations of LMR from pre-operative to post-treatment to pre-end of follow-up (pr-LMR-f) in predicting recurrence in Fn-positive CRC.
Results: In the total cohort and adjuvant therapy group cohort, pr-LMR-po independently predicted recurrence-free survival in Fn-positive CRC patients. In the adjuvant therapy group, pr-LMR-po (High-High vs Low-Low: HR: 3.896, 95% CI: 1.503– 10.095, p=0.005) was particularly significant. Meanwhile, pr-LMR-f can serve as a predictive biomarker for Fn-positive CRC recurrence, especially in the adjuvant therapy group cohort where the c-statistic for pr-LMR-f was 0.825 (95% CI: 0.804– 0.8251), with a sensitivity of 83.6% and a specificity of 79.3%. Compared to the overall adjuvant therapy group cohort, the prognostic performance of pr-LMR-f was superior in the Fn-positive CRC adjuvant therapy group cohort (AUC: 0.825 VS 0.711). Finally, we constructed a prediction model combining pr-LMR-f and CEA. After internal validation using the bootstrap resampling, the model had an AUC of 0.9295, a sensitivity of 94%, and a specificity of 72.7% in the Fn-positive CRC adjuvant therapy group cohort.
Conclusion: This study found that pr-LMR-po predicts Fn-positive CRC prognosis, and pr-LMR-f may predict Fn-positive CRC recurrence.

Keywords: longitudinal dynamic changes in LMR, Fusobacterium nucleatum, colorectal cancer, recurrence