Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma

Our plain-English summary of Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma, by A. Zhang, S. Cao, S. Jin, et al (Neoplasma, 2017).

The study

• Authors: A. Zhang, S. Cao, S. Jin, J. Cao, J. Shen, B. Pan, R. Zhu, Y. Yu
• Journal: Neoplasma
• Published: 2017;64(1):114-122
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Limited biomarkers predicting prognosis of malignant pleural mesothelioma (MPM) have been identified. The present study aims to assess potential laboratory prognostic factors of MPM. We retrospectively reviewed the clinical data of 105 patients with MPM. The overall survival and prognostic factors were assessed by Kaplan-Meier curves and Cox regression analysis. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values. The mean age of the 105 patients (62 men, 43 women) was 56.0 years. The major clinical presentations were dyspnea, cough and chest pain. The most common laboratory abnormalities were thrombocytosis and elevated monocyte count. Significant prognostic factors on univariate analysis were performance status (PS), serum albumin, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), monocyte, platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and treatment strategy. Multivariate analysis showed PS, AST, monocyte, and treatment strategy were statistically significant (p<0.05). Higher AST level and monocyte count were both related to the presence of anemia (p=0.001 and 0.010, respectively) and higher ALP level (p=0.049 and 0.001, respectively). A higher AST level was also associated with higher alanine aminotransferase (ALT) and LDH level (p<0.05). A higher monocyte count was also correlated with male patients, higher white blood cell (WBC), platelet, neutrophil counts, lower red blood cell (RBC) and LMR counts (p<0.05). In conclusion, our data show that PS<2, normal AST level, lower monocyte count, and multimodality treatment are independent positive prognostic factors of MPM. The elevated AST and monocyte levels represent unfavorable prognostic biomarkers of MPM.

In plain English

This was a retrospective study of 105 patients with pathologically confirmed malignant pleural mesothelioma (62 men, 43 women; mean age 56.0 years). They were registered at Harbin Medical University Cancer Hospital, China, from April 2007 to November 2013. The authors examined whether routine blood and liver tests at diagnosis were linked to survival. They stated that histologic type, stage and asbestos exposure could hardly be obtained and analyzed in detail. Median survival was 20.0 months (95% CI 13.947-26.053), and 68.2%, 40.8% and 13.8% of patients were alive at 1, 2 and 5 years. In the multivariate analysis, four factors were statistically significant: performance status (a measure of daily functioning), AST (a liver enzyme), monocyte count (a type of white blood cell) and treatment strategy. Compared with patients at or below these levels, the hazard ratio of death was 2.439 (95% CI 1.087-5.474) for AST above 40 U/L (11 patients) and 2.666 (95% CI 1.238-5.738) for monocytes above 0.545 x10^9/L. The authors concluded that elevated AST and monocyte levels are unfavorable prognostic biomarkers. They noted the study was small and retrospective, with unbalanced treatment groups.

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 analysis of hospital patient records (survival analysis of laboratory and clinical factors measured at diagnosis)
• Who was studied: 105 patients with pathologically confirmed malignant pleural mesothelioma (62 men, 43 women; mean age 56.0 years, range 18-77), registered and followed at Harbin Medical University Cancer Hospital, China, between April 2007 and November 2013
• Exposure: Asbestos exposure was not a studied variable. The study examined pretreatment laboratory values (blood counts, liver function tests, tumor markers), performance status and treatment strategy as possible predictors of survival. The authors state that asbestos exposure, histologic type and stage could hardly be obtained and analyzed in detail.
• Main results:
  • For all 105 patients, median survival was 20.0 months (95% CI 13.947-26.053).
  • For all 105 patients, survival rates at 1, 2 and 5 years were 68.2%, 40.8% and 13.8%.
  • The most common laboratory abnormalities were thrombocytosis (high platelet count; 59 of 105 patients, 56.2%) and elevated monocyte count (55 of 105, 52.4%).
  • In multivariate analysis, performance status (p less than 0.001), AST (p=0.031), monocyte count (p=0.012) and treatment strategy (p=0.007) were statistically significant predictors of survival.
  • Patients with AST above 40 U/L had a hazard ratio of death of 2.439 (95% CI 1.087-5.474) compared with patients with AST at or below 40 U/L.
  • Only 11 patients (10.5%) were in the high-AST group.
  • Patients with a monocyte count above 0.545 x10^9/L had a hazard ratio of death of 2.666 (95% CI 1.238-5.738) compared with patients at or below that level.
  • Patients with performance status of 2 or more (6 patients) had a hazard ratio of death of 6.178 (95% CI 2.228-17.130) compared with patients with performance status below 2.
  • Median survival was 2.3 months with best supportive care (15 patients), 22.5 months with non-surgical treatment such as chemotherapy (82 patients), and 29.7 months with surgery plus additional therapy (8 patients).
  • Higher AST and higher monocyte count were each associated with the presence of anemia (p=0.001 and p=0.010) and with higher ALP levels (p=0.049 and p=0.001).
  • In univariate analysis, a high CEA tumor marker level was associated with shorter survival among the 76 patients tested (median 8.7 vs 23.0 months, p less than 0.001).
• The authors' conclusion: The authors concluded that good performance status, normal AST level, low monocyte count and multimodality treatment were independent favorable prognostic factors in malignant pleural mesothelioma, and that elevated AST and monocyte levels represent unfavorable prognostic biomarkers.
• Limitations the authors state:
  • The study was a small retrospective analysis of 105 patients, and the numbers of patients in the different treatment groups were not well balanced.
  • Histologic type, stage at diagnosis and asbestos exposure could hardly be obtained and analyzed in detail.
  • Not all patients were tested for tumor markers, so the samples for those analyses were small.

Topics

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

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Mesothelioma, Biomarker, Overall Survival, Kaplan-Meier Curve, Dyspnea, Performance Status, Lactate Dehydrogenase (LDH).

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