Significance of EGFR and PTEN Expression and PLR and NLR for Predicting the Prognosis of Epithelioid Malignant Peritoneal Mesothelioma

Our plain-English summary of Significance of EGFR and PTEN Expression and PLR and NLR for Predicting the Prognosis of Epithelioid Malignant Peritoneal Mesothelioma, by Y. Liang, G. Zheng, W. Yin, et al (Gastroenterology Research and Practice, 2019).

The study

• Authors: Y. Liang, G. Zheng, W. Yin, H. Song, C. Li, L. Tian, D. Yang
• Journal: Gastroenterology Research and Practice
• Published: 2019;2019:7103915
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: The aim of our study was to investigate the expression of EGFR and PTEN in tissues and measure the serum platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) to evaluate the prognostic factors of patients with epithelioid malignant peritoneal mesothelioma (MPeM).

Methods: 33 patients of pathologically diagnosed epithelioid MPeM tissues were analyzed using immunohistochemistry to detect EGFR and PTEN; the PLR and NLR were determined by using a routine blood test. We analyzed the relationships of these markers to age, sex, asbestos exposure, elevated platelet count, ascites, and clinical stage.

Results: EGFR and PTEN expressions were positive in 22 (66.67%) and 7 (21.21%) epithelioid MPeM patients, respectively. However, these two markers as well as PLR and NLR were not significantly associated with age, sex, asbestos exposure, elevated platelet counts, ascites, and clinical stage (P > 0.05). The correlation between EGFR and PTEN was negative (r = -0.577, P < 0.001), but the correlation between NLR and PLR was positive (r = 0.456, P = 0.008). The median survival of all patients was 6 months. In univariate analysis, PTEN (P < 0.001), PLR (P = 0.014), and NLR (P = 0.015) affected the overall survival. Multivariate analysis revealed that PTEN and PLR were validated as predictive for overall survival of epithelioid MPeM (HR = 0.070, P = 0.001, and HR = 3.379, P = 0.007, respectively).

Conclusion: On the basis of these results, it is suggested that PTEN and PLR are risk factors for the prognosis of epithelioid MPeM, which may be targets for selective therapies and improve the outcomes of patients with epithelioid MPeM.

In plain English

This retrospective study from Cangzhou Central Hospital in China looked at 33 patients diagnosed with epithelioid malignant peritoneal mesothelioma between 2013 and 2015. Of these, 29 (87.88%) had a history of asbestos exposure. The article does not name fiber types. The authors stained tumor tissue for two proteins, EGFR and PTEN, and calculated two blood-count ratios: platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR). EGFR was found in 22 of 33 tumors and PTEN in 7. None of the four markers was significantly associated with age, sex, asbestos exposure, platelet count, ascites or stage. By the end of follow-up, 30 patients had died. Survival was 19.6% at 1 year and 4.4% at 2 years. Asbestos exposure was not a significant predictor of survival. In the analysis that weighed factors together, PTEN in the tumor was linked to a lower risk of death (hazard ratio 0.070, 95% confidence interval 0.014 to 0.344, P = 0.001). A PLR of 278 or more was linked to a higher risk (hazard ratio 3.379, 95% confidence interval 1.395 to 8.181, P = 0.007). NLR was not an independent predictor. The authors concluded that PTEN and PLR are prognostic factors, and called for larger prospective studies.

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 consecutive patients at one hospital (tissue immunohistochemistry plus routine blood tests, with survival analysis)
• Who was studied: 33 patients (9 men, 24 women, aged 42 to 75) with epithelioid malignant peritoneal mesothelioma diagnosed between 1 January 2013 and 31 December 2015 at Cangzhou Central Hospital, China, and followed until 31 December 2016
• Exposure: The study examined tumor EGFR and PTEN expression and blood PLR and NLR as possible predictors of survival. A history of asbestos exposure was recorded in 29 of 33 patients (87.88%). No fiber types, products, jobs or doses are given.
• Main results:
  • EGFR was expressed in 22 of 33 tumor specimens (66.67%). PTEN was expressed in 7 specimens (21.21%).
  • None of the four markers (EGFR, PTEN, PLR, NLR) was significantly associated with age, sex, asbestos exposure, elevated platelet count, ascites or clinical stage.
  • EGFR expression was negatively correlated with PTEN expression (r = -0.577, P less than 0.001). NLR was positively correlated with PLR (r = 0.456, P = 0.008).
  • All 33 patients were followed. By the end of observation, 30 had died and 3 were alive. Overall survival was 19.6% at 1 year and 4.4% at 2 years. The median survival of the patients who died was 6 months.
  • In single-factor (univariate) analysis, PTEN, PLR and NLR predicted survival. Median survival was:
• 15 months with PTEN-positive tumors (n = 7) versus 4 months with PTEN-negative tumors (n = 26).
• 10 months with PLR below 278 (n = 17) versus 4 months with PLR 278 or above (n = 16), P = 0.014.
• 9 months with NLR below 5 (n = 16) versus 4 months with NLR 5 or above (n = 17), P = 0.015.
  The authors required P less than 0.02 to count a factor as significant at this stage.
  • Asbestos exposure, EGFR, clinical stage and high platelet count were not significant predictors in the univariate analysis. Median survival was 6 months for the 29 patients with asbestos exposure and 3 months for the 4 without (P = 0.869).
  • In multivariate Cox analysis, two factors were independent predictors of survival:
• PTEN expression: hazard ratio 0.070 (95% CI 0.014 to 0.344), P = 0.001, linked to lower risk of death.
• PLR: hazard ratio 3.379 (95% CI 1.395 to 8.181), P = 0.007.
  NLR was not an independent predictor.
• The authors' conclusion: The authors concluded that PTEN and PLR are risk factors for the prognosis of epithelioid malignant peritoneal mesothelioma and suggested they may be targets for selective therapies.
• Limitations the authors state:
  • The study was a retrospective analysis. The authors state that large prospective studies are needed to confirm the reliability of the markers.
  • The authors note that EGFR (and clinical stage) did not reach significance in the univariate analysis partly because of the stricter P value threshold they chose.

Topics

Medical terms in this study, explained in our Lexicon: EGFR, Prognosis, Epithelioid, Peritoneal Mesothelioma, Immunohistochemistry, Asbestos Exposure, Ascites, Median Survival.

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