The Association Between Lymphocyte-Monocyte Ratio, Tumor-Infiltrating Lymphocytes, and Tumor-Associated Macrophages...

Nasopharyngeal cancer (NPC) is a major health burden in Indonesia, and reliable prognostic biomarkers are needed to guide treatment decisions. This study examined associations between lymphocyte-monocyte ratio (LMR), tumor-infiltrating lymphocytes (TILs), tumor-associated macrophages (TAMs), and 3-year progression-free survival (PFS) in advanced-stage NPC. A retrospective cohort was assembled at a national referral hematology-oncology clinic, including patients diagnosed from January 2015 to 2020. TIL and TAM expression were assessed by immunohistochemistry, and cutoffs for LMR, CD8, and CD163 were derived using receiver operating characteristic analysis. Kaplan-Meier methods with log-rank testing and Cox proportional hazards regression (univariable and multivariable) were applied. Median 3-year PFS was 24 months (95% CI: 19.44-25.04), with 46.7% event-free at 3 years. High LMR (>1.82) and high CD8+ TIL (>47.5%) were associated with higher 3-year PFS (56.3% and 59.3%) than low groups (31.7% and 30.4%). High CD163+ TAM (≥196) was associated with worse 3-year PFS (9.1% vs 73.8%; p < 0.001). In multivariable models, associations remained significant: LMR aHR 1.844 (p = 0.026), CD8 aHR 2.222 (p = 0.008), and CD163 aHR 5.680 (p < 0.0001). After adjustment for age, ECOG, body mass index, treatment type, sex, and stage (CD163 model), effect estimates were consistent with univariable findings. These biomarkers may aid risk stratification in advanced NPC.