Response to comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma'

Our plain-English summary of Response to comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma', by T.M. Meniawy, J. Creaney, R.A. Lake, et al (British Journal of Cancer, 2014).

The study

• Authors: T.M. Meniawy, J. Creaney, R.A. Lake, A.K. Nowak
• Journal: British Journal of Cancer
• Published: 2014;111(12):2377
• Type of article: Letter, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This item was a letter to the editor, not a new study. In it, the authors replied to criticism from Kao and colleagues of the authors' earlier paper, which had reported that existing prognostic models, but not the neutrophil-to-lymphocyte ratio (NLR, a measure taken from a blood count), predicted survival in malignant mesothelioma. The critics had argued that the earlier study's inclusion criteria caused selection bias. The authors acknowledged this as an inherent limitation of all retrospective studies, including previous NLR studies. They said they had screened all consecutive patients with confirmed disease, an available NLR result and no co-existing confounders. They rejected the claim that their patients had unusually good survival. Overall survival from the start of systemic therapy in their study was 12.3 months for all patients receiving chemotherapy and 11.7 months for those treated with chemotherapy only, which they said did not differ materially from figures in earlier studies. They said their NLR cut-off was chosen in advance from the critics' own published work. The authors concluded that their result did not reject the potential value of NLR but called for rigorous prospective research. The letter did not discuss asbestos exposure.

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: Letter to the editor (author reply to a published comment on the authors' earlier retrospective study)
• Who was studied: The letter describes the earlier study's patients only by its selection criteria: all consecutive patients with confirmed disease, an available NLR result and no co-existing confounders. No patient numbers, place or dates are given in this letter.
• Exposure: Not described. The letter concerns a blood-count measure (neutrophil-to-lymphocyte ratio) as a possible predictor of survival, not asbestos exposure.
• Main results:
  • In the authors' earlier study, the data did not support their initial hypothesis about NLR.
  • In the authors' study, overall survival from the start of systemic therapy was 12.3 months for all patients receiving chemotherapy and 11.7 months for those treated with chemotherapy only (non-surgically).
  • The authors said this survival did not differ materially from 12.1 months in the treatment arm of an earlier cisplatin/pemetrexed trial (Vogelzang et al, 2003) and 11.7 months in the chemotherapy-naive group of the first NLR study (Kao et al, 2010). These figures come from those other studies.
  • The authors stated that the NLR cut-off was chosen in advance from the critics' published work, not from their own data.
  • The authors stated that missing data were handled by multiple imputation.
• The authors' conclusion: The authors concluded that failing to confirm the earlier NLR finding does not reject the potential value of NLR, and that rigorous prospective research is needed.
• Limitations the authors state:
  • The authors acknowledged that the selection bias raised by the critics is an inherent limitation of retrospective studies, including theirs.
  • The authors noted that validating prognostic markers in retrospective series often gives conflicting findings, and that a prospective study is needed.

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: Malignant Mesothelioma.

Related studies

• Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma — T.M. Meniawy, J. Creaney, et al. (2013)
• 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)
• 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)
• 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)
• Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma — B.A. Özyürek, Ö. Özmen, et al. (2018)
• High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy — S.C. Kao, N. Pavlakis, et al. (2010)

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