Lymphocyte-to-Monocyte Ratio and Clinical Outcomes in Cholangiocarcinoma: A Systematic Review and Meta-Analysis.

Lymphocyte-to-Monocyte ratio (LMR) has shown an association with survival outcomes in several oncological diseases. This study aimed to evaluate the association between LMR and clinical outcomes for cholangiocarcinoma patients. A systematic review and meta-analysis were performed to assess the association between LMR values and overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and time to recurrence (TTR) in cholangiocarcinoma patients. We used Hazard ratio (HR) and their 95% confidence interval (CI) as a measure of effect for the random effect model meta-analysis. The Newcastle-Ottawa Scale was used for quality assessment. The Egger test and funnel plot were developed for approaching publication bias. A total of 19 studies were included in this study (n = 3860). The meta-analysis showed that cholangiocarcinoma patients with low values of LMR were associated with worse OS (HR: 0.82; 95% CI: 0.71-0.96; I 2 = 86%) and worse TTR (HR: 0.71; 95% CI: 0.58-0.86; I 2 = 0%). DFS and RFS also were evaluated; however, they did not show statistically significant associations. Low LMR values were associated with a worse OS and TTR.