Prognostic importance of the neutrophil-to-lymphocyte ratio in malignant peritoneal mesothelioma patients receiving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Prognostic importance of the neutrophil-to-lymphocyte ratio in malignant peritoneal mesothelioma patients receiving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by Z. Xinjing, G. Lei, L. Xinbao, et al (BMC Cancer, 2025).

The study

• Authors: Z. Xinjing, G. Lei, L. Xinbao, J. Zhonghe, Y. Zhiran, G. Chao, Z. Kai, Y. Lijun, Y. Guojun, Y. Junhui, Z. Yanbin, A. Songlin
• Journal: BMC Cancer
• Published: 2025;25(1):270
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare but aggressive cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was the preferred choice for selected patients. The purpose of this study was to thoroughly examine the impact of the combined treatment and the prognostic variables, particularly the neutrophil-to-lymphocyte ratio (NLR).

Methods: Characteristics of MPM patients who underwent CRS combined HIPEC treatment, followed by adjuvant chemotherapy were retrospectively collected. The univariable analysis was performed to identify the decisive influential factor. Using Kaplan-Meier analysis, the cumulative probability of survival was determined. Using Univariate Cox analysis, the prognostic factors-particularly NLR-and its correlation with survival were assessed. In the multivariate Cox proportional hazards model, predictive factors that demonstrated significance in univariate analysis were used. The degree of connection between predictors and survival was evaluated through the use of hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results: A total of 64 patients were enrolled in this study. The 1, 3, 5 years survival rates were 70.3%, 65.6%, 59.4%, respectively. According to multivariate Cox analysis, patients' survival was found to be substantially associated with post-operative NLR (HR 0.180, 0.067-0.531), Ki-67 (HR 0.184, 0.024-0.817), post-operative neutrophil count (HR 0.228, 0.075-0.696), and bidirectional pathological type (HR, 0.375, 0.146-0.964).

Conclusions: NLR is associated with the patients' prognosis after CRS combined HIPEC treatment.

© 2025. The Author(s).

In plain English

This retrospective case series, which had no control group, reviewed 64 patients (35 men, 29 women) with malignant peritoneal mesothelioma treated at Beijing Shijitan Hospital in China between June 2015 and December 2020. Every patient had cytoreductive surgery, meaning removal of visible tumor, plus heated chemotherapy circulated through the abdomen (HIPEC), followed by further chemotherapy. The study did not look at asbestos exposure. The authors examined whether the neutrophil-to-lymphocyte ratio (NLR), a blood measure of inflammation taken one month after surgery, was linked to survival. Overall survival was 70.3% at 1 year, 65.6% at 3 years and 59.4% at 5 years. Patients with lower post-operative NLR (cut-off 2.5125) had better overall survival (P<0.001). In the multivariate analysis, the authors reported four independent factors: post-operative NLR, Ki-67, post-operative neutrophil count and biphasic ("bidirectional") tumor type. Some printed hazard ratios do not clearly match the direction described in the text. The authors concluded that NLR is associated with prognosis after this treatment. They noted the study lacked controls and needs confirmation in larger multicenter trials.

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 case series from a single hospital, without a control group
• Who was studied: 64 patients (35 men, 29 women) with malignant peritoneal mesothelioma who received CRS combined with HIPEC at Beijing Shijitan Hospital, Capital Medical University, Beijing, China, June 2015 to December 2020. The tumors were 47 epithelioid, 16 biphasic/bidirectional and 1 sarcomatoid.
• Exposure: Asbestos or other fiber exposure was not studied. All patients received cytoreductive surgery plus HIPEC (usually cisplatin 120 mg and mitomycin 30 mg, at 42–43 °C for 60 to 90 minutes), followed by postoperative chemotherapy. The factor of main interest was the post-operative neutrophil-to-lymphocyte ratio.
• Main results:
  • In all 64 patients, overall survival rates were 70.3% at 1 year, 65.6% at 3 years and 59.4% at 5 years.
  • Post-operative NLR was calculated from a blood test taken 1 month after surgery, and patients were split into low and high groups (32 patients each).
  • The cut-off value separating low from high post-operative NLR, found by ROC curve analysis, was 2.5125.
  • In Kaplan-Meier analysis, post-operative NLR was significantly associated with survival (P<0.001).
  • Patients with lower post-operative NLR had higher overall survival rates.
  • In Kaplan-Meier analysis, a high post-operative neutrophil count (cut-off 6585/µl) was reported as a risk factor (P < 0.001). A high lymphocyte count (cut-off 1345/µl) was not (P = 0.231).
  • In univariate Cox analysis, survival was significantly associated with pathological type, Ki-67, post-operative NLR and post-operative neutrophil count. Factors such as age, sex, PCI, CC score and lymph node metastasis were not significantly associated.
  • In multivariate Cox analysis, the authors reported these hazard ratios (high vs. low, or >10 vs. ≤10 for Ki-67): post-operative NLR HR 0.180 (0.067–0.531); Ki-67 HR 0.184 (0.024–0.817); post-operative neutrophil count HR 0.228 (0.075–0.696).
  • In multivariate Cox analysis, bidirectional (biphasic) vs. epithelioid pathological type had HR 0.375 (0.146–0.964). The authors described this and the other three factors as independent risk factors.
• The authors' conclusion: The authors concluded that NLR is associated with patients' prognosis after CRS combined with HIPEC treatment.
• Limitations the authors state:
  • The study had no controls and was a retrospective case series.
  • Multicenter studies and larger randomized controlled trials are needed to validate the findings.
  • The mechanisms by which NLR may affect survival were not investigated and need further study.

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, Cytoreductive Surgery, HIPEC, Chemotherapy, Hazard Ratio, confidence interval, Ki-67, Prognosis.

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