Comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma'

Our plain-English summary of Comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma', by S.C. Kao, N. van Zandwijk, S. Clarke (British Journal of Cancer, 2014).

The study

• Authors: S.C. Kao, N. van Zandwijk, S. Clarke
• Journal: British Journal of Cancer
• Published: 2014;111(12):2376
• Type of article: Letter, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This was a letter to the editor, not a research study. The authors, from Sydney, commented on a 2013 article by Meniawy and colleagues. That article had concluded that the neutrophil-to-lymphocyte ratio (NLR), a measure from a routine blood count, did not predict survival in malignant pleural mesothelioma, while the existing CALGB and EORTC prognostic guides did. The authors argued that the earlier analysis had flaws. Of 369 consecutive patients, 95 (26%) were excluded, 64 of them for missing laboratory data, and excluded and included patients were not compared. The authors considered the reported median survival of 13.3 months for the whole group (15.3 months for those given chemotherapy) unusually good and suggestive of selection bias. They cited their own earlier presented cohort of 913 patients from Dust Diseases Board of New South Wales records. In a multivariate analysis that included 624 of those patients, an NLR above 5 was an independent poor prognostic factor (hazard ratio 1.21; confidence interval 1.02 to 1.44; P = 0.03). The authors concluded that prospective validation of NLR is warranted.

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: Letter to the editor commenting on another published study (no new data collected)
• Who was studied: No patients were studied in this letter. It discusses the Meniawy et al analysis, which was intended to cover 369 consecutive patients with malignant pleural mesothelioma at a single Western Australian treatment centre. After exclusions, 274 patients remained, and the letter criticises that reduction.
• Exposure: No asbestos exposure was studied. The letter concerns the neutrophil-to-lymphocyte ratio (NLR) as a prognostic indicator in malignant pleural mesothelioma.
• Main results:
  • In the Meniawy et al study, 95 of 369 patients (26%) were excluded, a majority (64) for missing laboratory data. According to the letter, the characteristics of excluded and included patients were not compared.
  • Of the remaining 274 patients in the Meniawy et al study, 169 received chemotherapy and 105 did not. Median survival was 13.3 months for the whole group and 15.3 months for the chemotherapy group. The letter's authors viewed these as unusually good survivals suggestive of selection bias.
  • The letter's authors cited their own earlier presented population-based cohort of 913 patients from Dust Diseases Board of New South Wales records (Linton et al, 2013). In a multivariate analysis with 624 patients in the model, an NLR above 5 was an independent poor prognostic factor (HR 1.21; CI 1.02 to 1.44; P = 0.03).
  • The letter's authors noted that Meniawy et al had observed significant predictive value of NLR normalisation after one cycle of chemotherapy, a finding the letter says was brushed over in that article.
• The authors' conclusion: The authors concluded that prospective validation of NLR is warranted. In their view, NLR is a relatively simple way to assess prognosis in certain groups of patients with malignant pleural mesothelioma, not a universal prognostic marker.
• Limitations the authors state:
  • For their own cited cohort, the authors acknowledged that clinical factors were not in the final multivariate model. Performance status was assessed only indirectly.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma.

Related studies

• Response to comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma' — T.M. Meniawy, J. Creaney, et al. (2014)
• Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma — T.M. Meniawy, J. Creaney, et al. (2013)
• 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 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)
• High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy — S.C. Kao, N. Pavlakis, et al. (2010)
• Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma — B.A. Özyürek, Ö. Özmen, et al. (2018)

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