Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma

Our plain-English summary of Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma, by B.A. Özyürek, Ö. Özmen, T.Ş. Özdemirel, et al (The Clinical Respiratory Journal, 2018).

The study

• Authors: B.A. Özyürek, Ö. Özmen, T.Ş. Özdemirel, Y. Erdoğan, B. Kaplan, T. Kaplan
• Journal: The Clinical Respiratory Journal
• Published: 2018;12(2):646-651
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of this study was to evaluate the relationship of the pre-treatment blood neutrophil/lymphocyte count ratio (NLR) with the maximum standard uptake value (SUVmax) of primary masses on positron emission tomography/computed tomography (PET/CT) taken before treatment in patients diagnosed with malignant pleural mesothelioma (MPM) and to evaluate the contribution to prognosis. A retrospective evaluation was made of 73 patients diagnosed with MPM in our hospital between January 2006 and January 2014. The SUVmax value of the primary mass on pre-treatment PET/CT, the haemogram parameters (Hb, Hct, NLR, MPV, PLT) at the time of diagnosis, the progression history, the date of the final visit, and the date of death of exitus patients was recorded from patient files PET/CT. The study group comprised 37 males (50.7%) with a mean age of 56.1 ± 11.4 years. The median survival time of these patients was 13 months. The survival time of the patient group aged <55 years was significantly longer (P = .006). Although the survival time of patients with NLR < 3 and SUVmax < 5 was longer, the difference was not statistically significant (P = .63, P = 0.08). A statistically significant difference was determined between the mean (or median) SUVmax values of the patient groups with NLR < 3 and NLR ≥3 (P = .019) with the SUVmax value of the NLR < 3 group found to be low. In conclusion, in patients with MPM, NLR ≥3 and high SUVmax values at the time of diagnosis can be considered an indicator of poor prognosis but are not a guide in the prediction of progression.

© 2016 John Wiley & Sons Ltd.

In plain English

This retrospective study reviewed records of 73 patients diagnosed with malignant pleural mesothelioma at an Ankara, Turkey hospital, 2006 to 2014. It asked whether the blood neutrophil/lymphocyte ratio (NLR) at diagnosis was related to tumour tracer uptake on PET/CT (SUVmax), and whether either predicted survival. Asbestos exposure was not studied. Median survival was 13 months; 55 patients died. Patients aged 54 or younger survived significantly longer than those 55 or older (25 versus 13 months, given in the table as means). Median survival was 23 versus 12 months for NLR below 3 versus 3 or higher, and 23 versus 13 months for SUVmax below 5 versus 5 or higher; neither difference was statistically significant. In a combined model on fewer than 73 patients, age 55 or older (hazard ratio 2.579, 95% CI 1.409-4.718) and SUVmax 5 or higher (2.363, 1.153-4.844) were associated with higher risk of death. Patients with NLR 3 or higher had higher SUVmax (median 7.91 versus 4.38). The authors concluded older age, NLR 3 or higher and high SUVmax might indicate poor prognosis, noting few patients as a limitation.

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 study of hospital patient records (survival analysis)
• Who was studied: 73 patients (37 men, 36 women; mean age 56.1 years) diagnosed with malignant pleural mesothelioma at a chest diseases hospital in Ankara, Turkey, January 2006 to January 2014. Pre-treatment PET/CT was available for 67 of them. Patients with a concurrent clinical infection were excluded.
• Exposure: Not an asbestos exposure study. The factors studied were the blood neutrophil/lymphocyte ratio at diagnosis (cut-off 3) and the SUVmax of the primary tumour on pre-treatment PET/CT (cut-off 5), together with age, sex, smoking, tumour type, grade and treatment.
• Main results:
  • Among all 73 patients, median survival was 13 months, and 55 patients died.
  • Survival was 25 months (95% CI 8.09-41.91) for patients aged 54 or younger and 13 months (95% CI 6.21-19.79) for those aged 55 or older (p=0.006). The text calls these medians, but a footnote to Table 2 says that for age the figures are means.
  • By NLR, median survival was 23 months (95% CI 19.19-26.81) for NLR below 3 and 12 months (9.22-14.78) for NLR 3 or higher (p=0.63). By SUVmax, it was 23 months (18.69-27.32) for SUVmax below 5 and 13 months (7.85-18.15) for SUVmax 5 or higher (p=0.08). Neither difference was statistically significant.
  • In the multivariable Cox model, patients aged 55 or older had a hazard ratio of 2.579 (95% CI 1.409-4.718) compared with those aged 54 or younger. The model did not include all 73 patients: the article does not state its total, but the group sizes in Table 3 (29 and 37 by age) add to 66.
  • In the same model, patients with SUVmax 5 or higher had a hazard ratio of 2.363 (95% CI 1.153-4.844) compared with those with SUVmax below 5. Tumour grade was not significantly related to the hazard ratio.
  • SUVmax was significantly lower in patients with NLR below 3 than in patients with NLR 3 or higher (p=0.019). For NLR below 3, the median was 4.38 and the mean was 4.39 plus or minus 2.59. For NLR 3 or higher, the median was 7.91 and the mean was 9.47 plus or minus 5.19.
  • One-year survival was 44.7% for patients with NLR 3 or higher and 73.3% for those with NLR below 3. No patient with NLR 3 or higher survived 5 years, compared with 20.4% of those with NLR below 3.
• The authors' conclusion: The authors concluded that older age at diagnosis (over 55 years), NLR of 3 or higher and high SUVmax values can be considered to increase the risk of death and might indicate poor prognosis. In the abstract, they added that these measures are not a guide for predicting disease progression.
• Limitations the authors state:
  • The small number of patients

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, Prognosis, Median Survival.

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• Bladder cancer invasion predictability based on preoperative neutrophil-lymphocyte ratio — M. Kaynar, M.E. Yıldırım, et al. (2014)
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