Analysis of prognostic factors of patients with malignant peritoneal mesothelioma

Our plain-English summary of Analysis of prognostic factors of patients with malignant peritoneal mesothelioma, by W. Yin, G. Zheng, K. Yang, et al (World Journal of Surgical Oncology, 2018).

The study

• Authors: W. Yin, G. Zheng, K. Yang, H. Song, Y. Liang
• Journal: World Journal of Surgical Oncology
• Published: 2018;16(1):44
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The study aims to find out independent prognostic factors for patients with malignant peritoneal mesothelioma (MPeM).

Methods: Patients with pathologically proven MPeM were retrospectively reviewed. Potential prognostic factors were analyzed, including age, gender, asbestos exposure, body mass index (BMI), treatment, and laboratory results, such as blood routine examination and liver functions. The influences of various risk factors on the prognoses were analyzed by univariate analysis. A Cox regression model analysis established independent factors for the survival prognosis of the patients.

Results: Seventy MPeM patients, including 33 patients who received intraperitoneal chemotherapy with cisplatin, 14 patients who received systemic chemotherapy with cisplatin + pemetrexed, and 21 untreated patients were included in this study. The 1-year survival was 32.9%, the 2-year survival was 10%, and the 3-year survival was 2.9%. The median age of MPeM was 62 years, and the female-to-male ratio was 1:0.56. The univariate and multivariate analyses showed that treatment, albumin (ALB), and blood neutrophil-to-lymphocyte ratio (NLR) were independent factors that affected the overall survival (OS) of MPeM patients.

Conclusion: High blood NLR and hypoalbuminemia are adverse prognostic factors for MPeM patients. Systemic chemotherapy and intraperitoneal chemotherapy can prolong the survival period.

In plain English

This retrospective study reviewed 70 consecutive patients with pathologically proven malignant peritoneal mesothelioma, a cancer of the abdominal lining, at Cangzhou Central Hospital, China, between January 2010 and December 2014. None had aggressive cytoreductive surgery. Thirty-five received intraperitoneal chemotherapy with cisplatin, 14 received systemic cisplatin plus pemetrexed, and 21 were untreated. Forty-five were women, and 57 (81.4%) had a history of asbestos exposure. Median overall survival was 10 months. In the multivariate analysis, treatment, blood albumin and the blood neutrophil-to-lymphocyte ratio (NLR) were independent prognostic factors. Median survival was 12 months with albumin of 35 g/L or more versus 6 months with lower albumin. It was 12 months with NLR below 3 versus 6 months with NLR of 3 or more. Mean survival was about 14.6 and 13.8 months in the two chemotherapy groups and 4.5 months in untreated patients, who were older. Asbestos exposure history was not a statistically significant predictor of survival. The authors concluded that high NLR and low albumin were adverse prognostic factors and that both chemotherapies prolonged survival. They called for a larger prospective study.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of consecutive hospital patients (prognostic factor analysis using Kaplan–Meier and Cox regression)
• Who was studied: 70 consecutive patients with pathologically proven malignant peritoneal mesothelioma at Cangzhou Central Hospital, Hebei Province, China, January 2010 to December 2014. There were 25 men and 45 women, with a median age of 62 years (range 42–85).
• Exposure: A history of asbestos exposure was recorded as one potential prognostic factor; 57 of 70 patients (81.4%) had such a history. The article does not specify fiber types or sources of exposure for these patients. The main factors studied were treatment, blood NLR and serum albumin.
• Main results:
  • For all 70 patients, median overall survival was 10 months (range 1–42 months).
  • In the body of the article, 1-year survival was 45.8%, 2-year survival was 11.4% and 3-year survival was 2.9% for all patients.
  • In the multivariate Cox model, albumin, NLR and treatment were independent prognostic factors.
  • Median survival was 12 months for patients with albumin of 35 g/L or higher and 6 months for patients with hypoalbuminemia (albumin below 35 g/L).
  • Median overall survival was 12 months for patients with NLR below 3 versus 6 months for NLR of 3 or more. One-year survival was 57.1% versus 32.4% in these two groups.
  • Mean survival was approximately 14.6 months in the intraperitoneal cisplatin group, 13.8 months in the systemic cisplatin plus pemetrexed group, and 4.5 months in the untreated group.
  • There was no statistically significant difference in survival between the intraperitoneal cisplatin group and the systemic cisplatin plus pemetrexed group.
  • The three treatment groups differed in age; the untreated group was older (15 of 21 untreated patients were 63 or older).
  • A history of asbestos exposure was not a statistically significant predictor of survival. The univariate hazard ratio was 1.082 (95% CI 0.588–1.992, p 0.8) and the multivariate hazard ratio was 1.135 (95% CI 0.636–2.025, p 0.669). Gender and histological subtype were also not predictors.
• The authors' conclusion: The authors concluded that a high blood NLR and hypoalbuminemia were adverse prognostic factors for patients with malignant peritoneal mesothelioma. They also concluded that systemic chemotherapy and intraperitoneal chemotherapy prolonged survival.
• Limitations the authors state:
  • The study was based on retrospective observations, and the authors said a larger prospective study is needed to verify the results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Prognosis, Chemotherapy, Cisplatin, Pemetrexed (Alimta), Overall Survival.

Related studies

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• Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy — S.C. Kao, S. Klebe, et al. (2011)
• Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis — D. Magge, M.S. Zenati, et al. (2014)
• Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression — L. Gutierrez-Sainz, P. Cruz, et al. (2021)
• Inflammation-based prognostic indices in malignant pleural mesothelioma — D.J. Pinato, F.A. Mauri, et al. (2012)

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