Background and Aims: The clinical significance of systemic inflammation assessed with laboratory analysis of blood samples has been validated in variety of cancers. hepatocellular carcinoma (HCC) is an inflammation-driven cancer, and inflammation has been shown to be correlated with poor differentiation, microvascular invasion and micrometastasis. This study was conducted to investigate the prognostic value of the lymphocyte-to-monocyte ratio (LMR) in patients with HCC after hepatectomy. 
Methods: The clinical data 88 HCC patients undergoing radical hepatectomy in the Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine between January 2012 and December 2016 were retrospectively analyzed. The prognostic predictive power of LMR for HCC was analyzed by ROC curve, which was compared with those of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). The relations of LMR with the clinicopathologic factors as well as the disease-free survival (DFS) and overall survival (OS) of the HCC patients were determined. The risk factors for DFS and OS were determined by Cox regression model.
Results: The cut-off diagnostic value of LMR determined by ROC was 2.87, and the area under the curve (AUC) was 0.757, and its efficiency in estimating the prognosis of HCC was greater than those of NLR (AUC=0.687) and PLR (AUC=0.583). The patients were divided into low LMR group (LMR ≤2.87) and high LMR group (LMR >2.87) according to the cut-off value of LMR. The number of cases with lesion number >3 in high LMR group was significantly less than that in low LMR group (P=0.048); both DFS and OS in high LMR group were significantly superior than those in low LMR group (both P<0.05); results of stage-stratified comparison (BCLC A/B, BCLC C/D; CNLC I/II, CNLC III/IV) showed that except the DFS had no significant difference between high LMR group and low LMR group among patients classified as CNLC I/II stage group (P=0.132), either DFS or OS in high LMR group were significantly superior than that in low LMR in all other stage groups (all P<0.05). LMR was an independent prognostic factor for DFS (P=0.001), while BCLC stage (P=0.000) and LMR (P=0.000) were independent prognostic factors for OS. In addition, after adjustment for LMR, PLR, and NLR as a continuous variable, only LMR had a prognostic value (P=0.001).
Conclusion: LMR is an independent prognostic factor for OS and DFS in HCC patients after hepatectomy, and its predictive value is possibly superior to that of NLR or PLR. Using LMR combined HCC stage to grade the risk of patients may probably make a more precise assessment.