Correlation between LMR and TLR4 Expression and Prognosis and Pathological Characteristics in Patients Undergoing Surgery for Colorectal Cancer

ZHOU Anchao; YANG Hao; AO Jing

doi:10.14033/j.cnki.cfmr.2026.04.005

Abstract：Objective:To investigate the correlation of lymphocyte to monocyte ratio(LMR)and Toll-like receptor 4(TLR4)expression with the prognosis and pathological features of patients undergoing surgery for colorectal cancer.Method:A retrospective study was conducted on 321 colorectal cancer patients admitted to the Nanchang County Hospital of Traditional Chinese Medicine between January 2019 and May 2022.All patients underwent laparoscopic total mesorectal excision.Postoperative clinical characteristics were observed and overall survival rates were recorded during follow-up.The optimal cut-off point for LMR was determined using a time-dependent receiver operating characteristic(ROC)curve.Participants were categorised into a high LMR level group(LMR>3.12,228 cases)and a low LMR level group(LMR≤3.12,93 cases)based on this optimal cut-off point.TLR4 expression was assessed via immunohistochemistry,with patients categorised into low-expression(≤4 points,177 cases)and high-expression(≥5 points,144 cases)groups based on immunohistochemical scoring.Postoperative clinical characteristics were observed in both high-and low-LMR groups alongside high-and low-TLR4 expression cohorts to evaluate prognostic outcomes.Result:All 321 patients underwent successful surgery.Among TNM stage III patients,six cases demonstrated localised poor intestinal anastomotic blood supply and excessive anastomotic tension during operation,with significant intestinal congestion and oedema.These patients underwent prophylactic double-lumen ileostomy at the terminal ileum.The remaining patients underwent primary anastomosis.The postoperative complication rate was 5.61%.Low-,medium-,and high-grade differentiated adenocarcinomas comprised 99,132,and 90 cases respectively.TNM staging revealed 90 cases at stage I,144 at stage II,and 87 at stage III.The overall survival rate at follow-up was 64.49%.The proportion of low-grade differentiation and TNM stage III disease was significantly higher in the low LMR level group and high TLR4 expression group compared to the high LMR level group and low TLR4 expression group,with statistically significant differences(P<0.05).The survival rate in the high LMR group was 67.11%,higher than the 58.06%survival rate in the low LMR group,and the survival rate in the high TLR4 expression group was 58.33%,lower than the 69.49%survival rate in the low TLR4 expression group,with statistically significant differences(P<0.05).Conclusion:Colorectal cancer patients with higher levels of LMR have a lower percentage of postoperative hypodifferentiation,TNM stage III,and a higher survival rate,while patients with higher levels of TLR4 expression have a higher percentage of postoperative hypodifferentiation,TNM stage III,and a lower survival rate.The levels of LMR and TLR4 expression can be used as specific indicators of clinical prognosis.