The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma

Our plain-English summary of The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma, by W. Yin, G. Zheng, S. Su, et al (Oncology Research and Treatment, 2019).

The study

• Authors: W. Yin, G. Zheng, S. Su, Y. Liang
• Journal: Oncology Research and Treatment
• Published: 2019;42(6):334-341
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/aims: To investigate differences in blood routine indexes and the expression of cyclooxygenase-2 (COX-2) and nuclear factor-kappa B (NF-κB) in malignant peritoneal mesothelioma (MPeM) and their relationship with clinical prognosis.

Methods: We investigated changes in blood routine indexes between the MPeM patients and healthy subjects and detected the expression of COX-2 and NF-κB in peritoneal tissues by a streptavidin-peroxidase immunohistochemistry method. Potential prognostic factors were analyzed including age, gender, white blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute platelet count (APC), absolute monocyte count (AMC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), COX-2, and NF-κB. Cox regression model analysis established independent factors for the survival prognosis of the patients.

Results: Compared with the control group, AMC, MXD%, ANC, neutrophilic granulocyte percentage (NEUT%), APC, NLR, MLR, and PLR were markedly increased (p < 0.05) in the MPeM group. The positivity rates for COX-2 and NF-κB expression were 59.4 and 44.9%, respectively. Single factor analyses indicated that PLR, NLR, MLR, COX-2, and NF-κB were factors that affected the overall survival of MPeM patients, but multivariate analyses identified MLR and COX-2 as independent prognostic factors.

Conclusions: High blood levels of MLR and COX-2 are adverse prognostic factors for patients with MPeM.

© 2019 S. Karger AG, Basel.

In plain English

This retrospective study reviewed 69 consecutive patients with malignant peritoneal mesothelioma (cancer of the abdominal lining) at Cangzhou Central Hospital, China, from 2011 to 2015. They were compared with 69 age-matched healthy people. Fifty-nine (85.5%) had confirmed asbestos exposure; fiber types were not reported. The authors used pre-treatment blood counts and stained tumors for inflammation-related proteins COX-2 and NF-κB. Median survival was 10 months. Patients had higher neutrophil, platelet and monocyte counts, and higher ratios of these to lymphocytes, than controls. COX-2 was positive in 41 of 69 patients, NF-κB in 31. Both markers, and high values of the three ratios, were linked to shorter survival. In a combined analysis, only the monocyte-to-lymphocyte ratio (hazard ratio 7.894, 95% CI 2.664 to 23.392) and COX-2 (hazard ratio 2.761, 95% CI 1.514 to 5.035) remained independent predictors. The article does not say how this ratio was coded there, so what its hazard ratio compares is unclear. The authors called these independent adverse prognostic factors and noted their study was retrospective and small. Some p values in the text contradict the article's table.

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 review of hospital patients, compared with age-matched healthy controls, with survival (prognostic factor) analysis using Kaplan-Meier curves and Cox regression
• Who was studied: 69 consecutive patients with pathologically proven malignant peritoneal mesothelioma (MPeM) at Cangzhou Central Hospital, China, January 2011 to December 2015. Median age was 62 (range 42 to 85); 24 were men and 45 women. Controls were the same number of age-matched healthy people who had physical examinations at the hospital in the same period. For treatment, 30 had intraperitoneal cisplatin, 16 had cisplatin plus pemetrexed, and 23 were untreated.
• Exposure: Asbestos exposure was confirmed in 59 of 69 patients (85.5%). Fiber types and exposure sources were not reported. The factors studied were pre-treatment blood counts and ratios (neutrophil-, platelet- and monocyte-to-lymphocyte ratios) and tumor tissue staining for COX-2 and NF-κB.
• Main results:
  • Among the 69 patients, median overall survival was 10 months (range 1 to 42 months). The 1-year survival rate was 40.58%, the 2-year rate 10.14% and the 3-year rate 2.9%.
  • Compared with the healthy control group, the MPeM group had significantly higher NLR, MLR, PLR, platelet count, monocyte count, neutrophil count and neutrophil percentage (p less than 0.05).
  • COX-2 staining was positive in 41 of 69 patients (59.4%). COX-2-positive patients had shorter overall survival (log-rank p printed as 0.000).
  • NF-κB staining was positive in 31 of 69 patients (44.9%). NF-κB-positive patients had shorter overall survival (p = 0.028).
  • For the Kaplan-Meier survival curves, patients were split at median values: PLR 242 or above, NLR 3 or above, and MLR 0.35 or above. In each case the higher group had significantly shorter overall survival (PLR p = 0.047, NLR p = 0.03, MLR p = 0.028).
  • In the multivariate Cox analysis, MLR (hazard ratio 7.894, 95% CI 2.664 to 23.392, p printed as 0.000) and COX-2 (hazard ratio 2.761, 95% CI 1.514 to 5.035, p = 0.001) were independent prognostic factors for overall survival.
  • The Methods say PLR, NLR and MLR were entered as continuous variables in the univariate Cox regression, and COX-2 and NF-κB as categories. The article does not state how MLR was coded in the multivariate model. It is therefore unclear whether the MLR hazard ratio of 7.894 compares the high and low groups or reflects a change in the ratio.
• The authors' conclusion: The authors concluded that blood cell counts change significantly in MPeM patients. They also concluded that high NLR, PLR and MLR and positive COX-2 and NF-κB staining are adverse prognostic factors, and that high MLR and positive COX-2 staining are independent adverse prognostic factors.
• Limitations the authors state:
  • The study was mainly retrospective and small, and the authors said a larger prospective study is needed to validate the results.
  • Data were collected only before treatment, so it is unknown whether these indicators decrease after treatment.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Prognosis, Peritoneal Mesothelioma, Immunohistochemistry, Overall Survival.

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