Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression

Our plain-English summary of Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression, by L. Gutierrez-Sainz, P. Cruz, S. Martinez-Recio, et al (Clinical & Translational Oncology, 2021).

The study

• Authors: L. Gutierrez-Sainz, P. Cruz, S. Martinez-Recio, O. Higuera, M.I. Esteban-Rodriguez, F. Arias-Lotto, R.A. Gonzalez, J. De Castro-Carpeño
• Journal: Clinical & Translational Oncology
• Published: 2021;23(10):2030-2035
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor, with a poor prognosis. MPM needs to find prognostic factors of survival. We provided the management of patients with MPM and sought to determine whether pre-treatment levels of derived neutrophil-to-lymphocyte ratio (dNLR) as well as PD-L1 expression were reliable prognostic factors of survival.

Methods: We conducted a single-institution retrospective study, including all patients with MPM treated at La Paz University Hospital between December 2009 and March 2018. Baseline disease, demographics, clinical data, treatment characteristics and complete blood cell counts were collected. We examined dNLR at baseline and data for PD-L1 expression were analyzed in tumor cells by immunohistochemistry.

Results: We included 25 patients. The median overall survival (OS) was 15.7 months (95% CI 11.3-20.0). 5 patients had a dNLR greater than 3 (20%). Patients with a dNLR greater than 3 had shorter median OS (8.5 months), than patients with a dNLR less than 3 (17.0 months), with statistically significant differences (p = 0.038). Ten patients (40%) had positive PD-L1 expression (≥ 1%). Patients with positive PD-L1 expression had shorter median OS (8.5 months) than patients with negative PDL1 expression (15.7 months), but without statistically significant association (p = 0.319).

Conclusion: The survival data obtained in our sample are consistent with those previously reported. Pretreatment levels of dNLR greater than 3 and positive PD-L1 expression could be significant prognostic factors for poor survival in patients with MPM. Further and prospective studies are needed to explore this relationship and to derive definitive conclusions.

© 2021. Federación de Sociedades Españolas de Oncología (FESEO).

In plain English

This retrospective study covered all 25 adults with malignant pleural mesothelioma treated at La Paz University Hospital, Madrid, Spain, between December 2009 and March 2018. It did not report the patients' asbestos exposure. The authors asked whether two measures were linked with survival: a blood-count ratio taken before treatment, called the derived neutrophil-to-lymphocyte ratio (dNLR), and tumor-cell expression of the protein PD-L1. Median overall survival was 15.7 months (95% confidence interval 11.3 to 20.0). The 5 patients with a dNLR greater than 3 had a median survival of 8.5 months (95% CI 0.0 to 18.2), versus 17.0 months (12.1 to 22.0) for the 20 with a dNLR of 3 or less. This difference was statistically significant (p = 0.038). Of 18 patients with known PD-L1 results, the 10 positive patients had a median survival of 8.5 months (0.5 to 16.4), versus 15.7 months (13.5 to 17.8) for the 8 negative patients. This difference was not statistically significant (p = 0.319). The authors concluded that both could be prognostic factors for poor survival and called for prospective studies. They noted the study was retrospective, single-institution and small.

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: Single-institution retrospective observational study
• Who was studied: 25 patients aged 18 or older with histologically confirmed malignant pleural mesothelioma, treated at La Paz University Hospital, Madrid, Spain, between December 2009 and March 2018. Of these, 19 (76%) were male, the median age was 71, 21 (84%) had stage IV disease and 22 (88%) had epithelioid histology.
• Exposure: The study did not report the patients' asbestos exposure. It studied two factors: the derived neutrophil-to-lymphocyte ratio (dNLR) measured before treatment, with a cut-off of greater than 3, and tumor-cell PD-L1 expression measured by immunohistochemistry, counted as positive at 1% or more.
• Main results:
  • Median overall survival for all 25 patients was 15.7 months (95% CI 11.3 to 20.0).
  • Of the 22 patients given first-line platinum-pemetrexed chemotherapy, 5 (22.7%) had a partial response and 15 (68.2%) had stable disease.
  • Median overall survival was 8.5 months (95% CI 0.0 to 18.2) for the 5 patients with dNLR greater than 3, versus 17.0 months (95% CI 12.1 to 22.0) for those with dNLR of 3 or less. This difference was statistically significant (p = 0.038).
  • Median progression-free survival was 8.6 months for patients with dNLR greater than 3, versus 13.5 months for those with dNLR of 3 or less. This difference was not statistically significant (p = 0.304).
  • Of the 25 patients, 10 (40%) were PD-L1 positive, 8 (32%) were PD-L1 negative and 7 (28%) had unknown PD-L1 status.
  • Median overall survival was 8.5 months (95% CI 0.5 to 16.4) for PD-L1 positive patients, versus 15.7 months (95% CI 13.5 to 17.8) for PD-L1 negative patients. This difference was not statistically significant (p = 0.319).
  • Median progression-free survival was 8.4 months for PD-L1 positive patients, versus 15.5 months for PD-L1 negative patients. This difference was not statistically significant (p = 0.369).
• The authors' conclusion: The authors concluded that a pre-treatment dNLR greater than 3 and positive PD-L1 expression could be significant prognostic factors for poor survival in malignant pleural mesothelioma. They said further, prospective studies are needed before definitive conclusions can be drawn.
• Limitations the authors state:
  • The study was retrospective and was carried out at a single institution.
  • The sample was small because the disease is rare. The authors said this contributed to the PD-L1 analysis not reaching statistical significance.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, PD-L1, Prognosis, Immunohistochemistry, Median Overall Survival.

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