Pretreatment Controlling Nutritional Status Score and Lactate Dehydrogenase as Predictive Markers of Survival in Patients with Malignant Peritoneal Mesothelioma

Our plain-English summary of Pretreatment Controlling Nutritional Status Score and Lactate Dehydrogenase as Predictive Markers of Survival in Patients with Malignant Peritoneal Mesothelioma, by Q.Q. Wang, G.Q. Zheng, D.L. Yang, et al (Nutrition and Cancer, 2018).

The study

• Authors: Q.Q. Wang, G.Q. Zheng, D.L. Yang, Y.F. Liang, W.J. Yin, S.S. Su
• Journal: Nutrition and Cancer
• Published: 2018;70(8):1264-1274
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To investigate the relationships between the Controlling Nutritional Status (CONUT) score and ascites fluid lactate dehydrogenase (LDH) level, and prognosis in patients with malignant peritoneal mesothelioma (MPeM).

Methods: A total of 125 patients with MPeM were selected for the study using a pathological screening method. Once the diagnosis is established, before the treatment their clinical characteristics and nutritional evaluations were recorded including CONUT score and ascites LDH level. The associations between CONUT, ascites LDH, and other clinicopathological features including body mass index, asbestos exposure, pathological type, and treatment method were analyzed. Prognostic parameters predicting overall survival (OS) were analyzed by Cox regression.

Results: High CONUT score, high ascites LDH level were positively associated with poor prognosis in patients with MPeM according to univariate analyses (P < 0.001, P < 0.001, respectively), and CONUT score and ascites LDH were independent predictors of a poor prognosis according to multivariate analysis. When the CONUT score is greater than 3 and the ascites LHD is greater than 474 IU/l, it indicates a poor prognosis.

Conclusions: CONUT score and ascites LDH are important factors influencing the prognosis of MPeM patients and should thus be considered in clinical applications.

In plain English

This retrospective study from a single hospital in Cangzhou, China, looked at 125 patients diagnosed with malignant peritoneal mesothelioma between February 2011 and March 2017. Before treatment, the authors recorded two measures. One was each patient's Controlling Nutritional Status (CONUT) score, built from blood albumin, cholesterol and lymphocyte count. The other was the level of the enzyme lactate dehydrogenase (LDH) in abdominal fluid (ascites). Of the patients, 74 (59.2%) had been exposed to asbestos. The article does not describe fiber types or amounts of exposure. Median survival was 8 months. In the multivariate analysis, CONUT score and ascites LDH were each independent predictors of overall survival. The table treats both as measured values: risk ratio 1.263 (95% CI 1.158–1.378) per CONUT point and 1.001 (95% CI 1.000–1.001) per 1 IU/l of LDH. The best cutoffs were 2.5 for CONUT and 474 U/l for LDH. In the univariate analysis, asbestos exposure was not a statistically significant predictor of survival (risk ratio 0.888, 95% CI 0.588–1.342). The authors concluded that higher pretreatment CONUT score and ascites LDH predicted a poor prognosis. They noted the study was small, retrospective and from one institution.

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 single-institution study of survival (prognostic factors analyzed by Cox regression)
• Who was studied: 125 patients diagnosed with malignant peritoneal mesothelioma (MPeM) between February 2011 and March 2017 at Cangzhou Central Hospital, Hebei, China; 79 women and 46 men; 122 epithelioid tumors
• Exposure: The factors studied were pretreatment CONUT nutritional score (from serum albumin, cholesterol and lymphocyte count) and ascites fluid LDH level. Asbestos exposure was recorded only as present or absent (74 exposed, 51 not exposed), with no fiber types, jobs or doses given.
• Main results:
  • Across all 125 patients, median survival was 8 months, and 28 patients were still alive at the end of follow-up.
  • CONUT score, entered in the table as a score (per point), predicted overall survival. The risk ratio was 1.334 (95% CI 1.238–1.437, P less than 0.001) in univariate analysis and 1.263 (95% CI 1.158–1.378, P less than 0.001) in multivariate analysis.
  • Ascites LDH, entered in the table in IU/l (per 1 IU/l), predicted overall survival. The risk ratio was 1.001 (95% CI 1.001–1.002, P less than 0.001) in univariate analysis and 1.001 (95% CI 1.000–1.001, P = 0.005) in multivariate analysis.
  • ROC analysis set the best cutoffs at 2.5 for the CONUT score (AUC 0.861, 95% CI 0.797–0.924) and 474 U/l for ascites LDH (AUC 0.770, 95% CI 0.681–0.859).
  • Asbestos exposure was not a statistically significant predictor of overall survival in univariate analysis (risk ratio 0.888, 95% CI 0.588–1.342, P = 0.574). It was also not significant in multivariate analysis (risk ratio 1.086, 95% CI 0.706–1.671, P = 0.707).
  • Ascites LDH group (high vs low) was not significantly related to age, sex, asbestos exposure, BMI or chemotherapy. The authors also reported no significant relationship between CONUT group and these factors.
  • Overall survival of patients given systemic chemotherapy was not significantly longer than that of patients given local intraperitoneal chemotherapy.
• The authors' conclusion: The authors concluded that pretreatment CONUT score and ascites LDH levels were independent predictive factors of a poor prognosis in MPeM patients and may have beneficial clinical applications.
• Limitations the authors state:
  • The study was retrospective and done at a single institution.
  • Peritoneal mesothelioma is rare and the number of cases was small, which could affect the results.
  • Few sarcoma-type tumors were included, which limited the ability to assess the factors by tumor type.
  • Other nutritional indices could not be compared because detailed nutritional information was not collected.

Topics

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

Medical terms in this study, explained in our Lexicon: Lactate Dehydrogenase (LDH), Peritoneal Mesothelioma, Ascites, Prognosis, Asbestos Exposure, Overall Survival, Multivariate Analysis.

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