The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit of Multimodality Treatment in Pleural Mesothelioma

Our plain-English summary of The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit of Multimodality Treatment in Pleural Mesothelioma, by B. Mosleh, K. Sinn, A. Cho, et al (Cancers, 2025).

The study

• Authors: B. Mosleh, K. Sinn, A. Cho, A. Reiner, A. Steindl, C. Lang, S. Zöchbauer-Müller, K. Dieckmann, J. Widder, H. Prosch, B. Dome, K. Schelch, C. Aigner, T. Klikovits, M. Benej, S. Watzka, M. Filipits, S. Bölükbas, P. Sarova, D. Gompelmann, M. Grusch, M.A. Hoda
• Journal: Cancers
• Published: 2025;17(8)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/objectives: Malignant pleural mesothelioma (MPM) remains challenging to treat, with a poor prognosis. As controversy about clinical management continues, predictive biomarkers for patient selection to indicate the benefit of treatment modalities are urgently needed.

Methods: In a retrospective analysis of 195 patients between 1994 and 2020 at the Department of Thoracic Surgery, Medical University of Vienna, Austria, the Mesothelioma Systemic Inflammation Score (MSIS)-consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen-was tested for its prognostic and predictive significance. The prognostic impact of MSIS was subsequently validated in an independent cohort of 80 patients treated at the Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, Vienna, Austria.

Results: Median overall survival (OS) was 14 months for the entire cohort (95% CI: 11.4-16.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6-26.0; p < 0.001). In multivariable analysis, MSIS (p < 0.001), disease stage (p = 0.001), and the type of treatment (p = 0.004) were confirmed as independent predictors for OS. Higher MSIS was associated with shorter OS (p < 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (≤ 2) MSIS, multimodality therapy was associated with significantly prolonged OS when compared with chemo- and/or radiotherapy alone (25.8 months [95% CI: 16.4-35.3] vs. 14.4 months [95% CI: 10.4-18.4], p < 0.001). In contrast, among patients with elevated MSIS, no survival benefit was achieved by surgery over conservative treatment (11.8 months [95% CI: 8.3-15.3] vs. 8.2 months [95% CI: 5.2-11.3], p = 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort (p < 0.001).

Conclusions: The Mesothelioma Systemic Inflammation Score was found to be an independent prognostic score in pleural mesothelioma, predicting benefit from macroscopic complete resection as part of multimodality treatment in distinct patients.

In plain English

This retrospective study reviewed 195 patients with malignant pleural mesothelioma diagnosed 1994–2020 at the Medical University of Vienna. The authors scored one point each for raised neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein and fibrinogen, forming the Mesothelioma Systemic Inflammation Score (MSIS, 0–4). Median overall survival for all patients was 14 months (95% CI 11.4–16.6). Median survival fell from 24.0 months (95% CI 11.4–36.5) at score 0 to 8.4 months (95% CI 3.2–13.6) at score 4. In multivariable analysis, the score, disease stage and treatment type were independently associated with survival. Among patients scoring 2 or less, median survival was 25.8 months (95% CI 16.4–35.3) with surgery-based multimodality treatment versus 14.4 months (95% CI 10.4–18.4) with chemotherapy and/or radiotherapy alone (p less than 0.001). Among patients scoring above 2, the difference (11.8 months, 95% CI 8.3–15.3, versus 8.2 months, 95% CI 5.2–11.3; p = 0.233) was not statistically significant. Median survival also fell with rising scores in 80 validation-cohort patients. The authors concluded the score predicted benefit from surgery-based treatment in distinct patients. They noted possible selection bias from the retrospective design.

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 cohort study with an external validation cohort
• Who was studied: 195 consecutive patients with histologically confirmed malignant pleural mesothelioma (147 male, 75%; median age 67) diagnosed 1994 to 2020 at the Department of Thoracic Surgery, Medical University of Vienna, Austria. A validation cohort of 80 patients came from the Department of Thoracic Surgery, Karl Landsteiner Institute, Clinic Floridsdorf, Vienna.
• Exposure: The study did not examine asbestos exposure. It examined the pretreatment MSIS and the type of treatment. The MSIS gives one point each for NLR 5 or more, PLR 160 or more, fibrinogen 537.5 mg/dL or more, and CRP 1 mg/dL or more, for a score of 0 to 4. Each patient received one of three treatments: surgery-based multimodality treatment (90 patients), chemotherapy and/or radiotherapy (80), or best supportive care (25).
• Main results:
  • In the whole cohort of 195, median overall survival was 14 months (95% CI 11.4 to 16.6). Survival was 56% at 1 year, 17% at 3 years and 10% at 5 years.
  • Median overall survival differed by treatment (p less than 0.001). It was 22.3 months after surgery-based multimodality therapy, 9.8 months after chemotherapy and/or radiotherapy alone, and 8.8 months with best supportive care.
  • In the Vienna cohort, median overall survival fell as MSIS rose (p less than 0.001). It was 24.0 months (95% CI 11.4 to 36.5) at MSIS 0, 20.7 months at 1, 15.8 months at 2, 11.2 months at 3, and 8.4 months (95% CI 3.2 to 13.6) at 4.
  • In multivariable analysis, three factors were independently associated with overall survival: treatment (p = 0.004), stage (p = 0.001) and MSIS (p less than 0.001).
  • Among patients with low MSIS (2 or less), median overall survival was 25.8 months (95% CI 16.4 to 35.3) after surgery within multimodality treatment. It was 14.4 months (95% CI 10.4 to 18.4) after chemotherapy and/or radiotherapy alone (p less than 0.001).
  • Among patients with elevated MSIS (above 2), median overall survival was 11.8 months (95% CI 8.3 to 15.3) with surgery within multimodality protocols and 8.2 months (95% CI 5.2 to 11.3) with chemotherapy and/or radiotherapy. The difference was not statistically significant (p = 0.233).
  • In the validation cohort of 80 patients, median overall survival also fell with higher MSIS: 23.4, 20.3, 17.2, 16.9 and 12.1 months for MSIS 0 to 4 (p less than 0.001).
  • Six patients (8.2%) died within 30 days of extrapleural pneumonectomy, out of 73 who had that operation.
  • Higher pretreatment MSIS was associated with more advanced disease stage (p = 0.001).
• The authors' conclusion: The authors concluded that the Mesothelioma Systemic Inflammation Score predicted benefit from macroscopic complete resection as part of multimodality treatment in distinct patients.
• Limitations the authors state:
  • The study was retrospective and based at a single center.
  • Because the study was retrospective, the way patients were assigned to treatments may reflect selection bias.
  • The authors stated that the score needs further validation, ideally in a prospective study.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Inflammation, Overall Survival, Pleural Mesothelioma, Prognosis, Biomarker, Thoracic Surgery, Median Overall Survival.

Related studies

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• Impact of Neoadjuvant and Adjuvant Pleural Intensity-Modulated Radiotherapy in Multimodality Treatment for Malignant Pleural Mesothelioma — B. Mosleh, S. Schwarz, et al. (2025)
• Pre-treatment Tumor Volume Growth Rate and Baseline Volume Measured by an Artificial Intelligence Program Predict Overall Survival in Patients With Pleural Mesothelioma Undergoing Deferred Systemic Therapy — I. Smesseim, V. Pugliese, et al. (2026)
• Progression free survival rate at 9 and 18 weeks predict overall survival in patients with malignant pleural mesothelioma: an individual patient pooled analysis of 10 European Organisation for Research and Treatment of Cancer Lung Cancer Group studies and an independent study validation — B. Hasan, L. Greillier, et al. (2014)
• A New Prognostic Score Supporting Treatment Allocation for Multimodality Therapy for Malignant Pleural Mesothelioma: A Review of 12 Years' Experience — I. Opitz, M. Friess, et al. (2015)
• Expression of ALCAM (CD166) and PD-L1 (CD274) independently predicts shorter survival in malignant pleural mesothelioma — S. Inaguma, J. Lasota, et al. (2018)

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