Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma

Our plain-English summary of Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma, by A.C. Tanrikulu, A. Abakay, H. Komek, et al (Environmental Health and Preventive Medicine, 2016).

The study

• Authors: A.C. Tanrikulu, A. Abakay, H. Komek, O. Abakay
• Journal: Environmental Health and Preventive Medicine
• Published: 2016;21(5):304-311
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Inflammation plays a role in malignant pleural mesothelioma (MPM) prognosis and symptoms. We investigated the roles of the new and old inflammatory indexes and markers in MPM prognosis.

Methods: Two hundred and ninety-two MPM patients (167 male and 125 female) were included in this retrospective study. Demographic parameters were collected from the patients' files. Kaplan-Meier curves and multivariate Cox regression analyses were used for the analysis of prognosis.

Results: The mean age of the patients was 58.4 years. The mean survival time was 14.6 ± 13.0 months. Twenty-four potential prognostic factors associated with a poor outcome were calculated in the univariate analysis, and 16 potential prognostic factors were associated with a poor prognosis. These 16 potential prognostic factors were also analyzed in multivariate analysis. Multivariate analysis showed that increased age, stage 3-4 disease, the non-epithelial type, a low Karnofsky performance score, a high white blood cell count, and a low lymphocyte-to-monocyte ratio (LMR) were associated with a poor prognosis. The results of the multivariate analysis showed that a decreased LMR was associated with poor survival. Patients with LMR ≤2.6 had poor survival compared with those with LMR >2.6 (mean 9.6 vs. 17.0 months, respectively; p = 0.004).

Conclusions: LMR is an independent marker of prognosis in patients with MPM and is superior to the other inflammation-based markers. The inexpensive nature and easy reproducibility of the hemogram should encourage the use of the LMR in clinical practice.

In plain English

This retrospective study reviewed records of 292 patients with malignant pleural mesothelioma treated at a hospital in Diyarbakir, Turkey, from 2005 to 2015. It tested whether blood-count inflammation measures at diagnosis were linked to survival. Of these, 174 (59.6%) had recorded asbestos exposure; fiber types were not given. Mean survival was 14.6 months. In multivariate analysis, older age, stage 3 to 4 disease, a low Karnofsky performance score, a low lymphocyte-to-monocyte ratio (LMR) and tumors not classed as epithelial (91 patients, 67 of them of unidentified subtype) were linked to poorer survival. The authors also listed a high white blood cell count, which their table shows as not statistically significant. Of the 283 patients with an LMR result, the 104 at 2.6 or less had a mean survival of 9.6 months, against 17.0 months for the 179 above 2.6 (hazard ratio 1.8, 95% CI 1.2 to 2.7). The neutrophil-lymphocyte and platelet-to-lymphocyte ratios and two combined platelet scores were linked to survival only in single-factor analysis. The authors concluded that the LMR is an independent prognostic marker needing validation in a large prospective study.

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-center study of patient records (survival analysis using Kaplan-Meier curves and Cox regression)
• Who was studied: Patients with malignant pleural mesothelioma confirmed by histopathology, diagnosed and treated at Dicle University Hospital, Diyarbakir, Turkey, May 2005 to December 2015. Of 338 patients, 46 were excluded for lack of data or active infection, leaving 292 (167 male, 125 female). Their mean age was 58.4 years (range 22 to 87).
• Exposure: The study examined inflammatory blood markers measured at diagnosis in relation to survival. These were the lymphocyte-to-monocyte ratio, neutrophil-lymphocyte ratio, derived NLR, platelet-to-lymphocyte ratio, neutrophil-platelet score, COP-NLR, MPV, RDW and others. A history of asbestos exposure was recorded in 174 patients (59.6%). No fiber types or doses were reported.
• Main results:
  • Mean survival for all 292 patients was 14.6 ± 13.0 months.
  • In the multivariate analysis, the authors reported that six factors were associated with a poor prognosis: increased age, stage 3 to 4 disease, the non-epithelial type, a low Karnofsky performance score, a high white blood cell count and a low LMR.
  • The histology comparison set 201 epithelial tumors against an 'Others' group of 91 patients (81 deaths). That group was made up of 16 mixed, 8 sarcomatous and 67 unidentified subtypes. Mean survival was 13.0 months for epithelial tumors and 12.1 months for the others. The multivariate hazard ratio was 1.5 (95% CI 1.1 to 2.0, p = 0.011).
  • LMR was available for 283 patients. Those with an LMR of 2.6 or less (91 deaths among 104 patients) had a mean survival of 9.6 months. Those with an LMR above 2.6 (148 deaths among 179) had a mean survival of 17.0 months. The multivariate hazard ratio was 1.8 (95% CI 1.2 to 2.7, p = 0.004), which the authors described as a 1.8-fold increased mortality rate.
  • Butchart stage 3 to 4 had a multivariate hazard ratio of 1.7 (95% CI 1.2 to 2.3, p = 0.002) compared with stage 1 to 2. A Karnofsky performance score of 60% or less had a hazard ratio of 2.2 (95% CI 1.5 to 3.2).
  • For white blood cell count, Table 2 gives a multivariate hazard ratio of 1.4 (95% CI 0.9 to 2.3, p = 0.2). This is not statistically significant, although the text lists a high white blood cell count among the multivariate findings.
  • Some other inflammatory markers were associated with survival in univariate but not multivariate analysis: NLR, derived NLR, PLR, COP-NLR and NPS, as well as low albumin. In multivariate analysis, the authors found a stronger relationship for LMR than for these markers. The CRP-to-albumin ratio, RDW and MPV were not significant even in univariate analysis.
• The authors' conclusion: The authors concluded that the LMR is an independent marker of prognosis in malignant pleural mesothelioma and is superior to the other inflammation-based markers. They added that the low cost and easy reproducibility of the blood count should encourage its use in clinical practice.
• Limitations the authors state:
  • The study was retrospective and carried out at a single center.
  • Treatment regimens and outcomes were not investigated.
  • The authors stated that the index must be validated in a large, prospective study.

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: Pleural Mesothelioma, Inflammation, Prognosis, Kaplan-Meier Curve, Multivariate Analysis.

Related studies

• Prognostic significance of the lymphocyte-to-monocyte ratio in patients with malignant pleural mesothelioma — T. Yamagishi, N. Fujimoto, et al. (2015)
• 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)
• 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)
• Comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma' — S.C. Kao, N. van Zandwijk, et al. (2014)
• 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)

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