The value of inflammatory parameters in the prognosis of malignant mesothelioma

Our plain-English summary of The value of inflammatory parameters in the prognosis of malignant mesothelioma, by O. Abakay, A.C. Tanrikulu, Y. Palanci, et al (The Journal of International Medical Research, 2014).

The study

• Authors: O. Abakay, A.C. Tanrikulu, Y. Palanci, A. Abakay
• Journal: The Journal of International Medical Research
• Published: 2014;42(2):554-65
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: This study investigated the relationship between potential prognostic parameters that may be associated with increased inflammation and survival in patients with malignant mesothelioma (MM).

Methods: This retrospective study assessed potential prognostic parameters measured at the time of MM diagnosis. Data on asbestos exposure, histopathological subtype of MM and laboratory parameters were collected.

Results: In 155 patients with MM (90 male), mean survival time was 13.9 months. In univariate analysis, age ≥ 60 years and neutrophil-to-lymphocyte ratio (NLR) ≥ 3 were associated with significantly shortened median survival times. In multivariate analysis, nonepithelial subtype, red cell distribution width (RDW) ≥ 20% and NLR ≥ 3 were associated with significantly shortened median survival times. Mortality rate was increased 2.77-, 1.67- and 1.52-fold in patients with RDW ≥ 20%, NLR ≥ 3 and nonepithelial subtype, respectively. Nonepithelial subtype, white blood cell count ≥ 11 200 µl and platelet-to-lymphocyte ratio ≥ 300 at baseline were associated with a heightened NLR value.

Conclusions: The NLR and RDW were significant predictive factors for MM prognosis.

In plain English

This retrospective study from Dicle University, Turkey, examined whether inflammation-related blood measures taken at diagnosis were related to survival in malignant mesothelioma. The authors reviewed the files of 155 patients (90 men) diagnosed between November 2003 and November 2012. Most had pleural disease, and 100 had environmental asbestos exposure, for a mean of 31.2 years. Mean survival was 13.9 months. In adjusted analysis, three features were tied to higher mortality: a red cell distribution width (RDW) of 20% or more (hazard ratio 2.77, 95% confidence interval 1.28 to 6.00; 9 patients versus 143), a neutrophil-to-lymphocyte ratio (NLR) of 3 or more (1.67, 1.14 to 2.46), and a nonepithelial subtype (1.52, 1.07 to 2.31). Age 60 or over was linked to shorter survival only in the unadjusted analysis. Platelet-to-lymphocyte ratio, mean platelet volume, LDH, platelet count, white cell count and haemoglobin showed no significant association with survival at the cut-offs used. The authors concluded that NLR and RDW were significant predictive factors for mesothelioma prognosis. They noted that the study was retrospective, that treatment regimens and outcomes were unavailable, and that files lacked consistent data on disease stage and performance status.

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 patient files (survival analysis of prognostic factors measured at diagnosis, before treatment)
• Who was studied: 155 patients with histopathologically confirmed malignant mesothelioma diagnosed between November 2003 and November 2012, with files at the Research Hospital, Dicle University, Diyarbakir, Turkey. Of 198 patients with laboratory data, 36 were excluded for insufficient data and 7 for active infection or other diseases. 90 were male and 65 female, mean age 58.2 years, and 32 were alive at the time of the study. 139 had pleural, 19 peritoneal and one pericardial mesothelioma. 100 had epithelial subtype, 6 sarcomatous, 6 mixed, and 43 unidentified.
• Exposure: The factors studied were blood measures taken at diagnosis: neutrophil-to-lymphocyte ratio (NLR, cut-off 3), platelet-to-lymphocyte ratio (cut-off 300), red cell distribution width (RDW, cut-off 20%), mean platelet volume (cut-off 8 fl), LDH, platelet count, white cell count and haemoglobin. Age, sex and histological subtype were also studied. Asbestos exposure was recorded but was not analysed as a prognostic factor: 100 patients (64.5%) had environmental asbestos exposure, with a mean exposure time of 31.2 years. No fiber type was named.
• Main results:
  • Unadjusted (univariate) analysis, by age: median survival was 15.70 months for patients under 60 (60 of 81 died) and 11.90 months for those 60 or older (63 of 74 died), P = 0.032. Age was not significant in the multivariate analysis.
  • Unadjusted (univariate) analysis, by NLR: median survival was 14.90 months with NLR under 3 (61 of 82 died) and 10.50 months with NLR 3 or more (58 of 67 died), P = 0.004.
  • Multivariate analysis: NLR 3 or more was associated with a 1.67-fold increased mortality rate compared with NLR under 3 (95% CI 1.14 to 2.46, P = 0.009).
  • Multivariate analysis: RDW 20% or more was associated with a 2.77-fold increased mortality rate compared with RDW under 20% (95% CI 1.28 to 6.00, P = 0.010). Only 9 patients had RDW 20% or more (8 died), with a median survival of 8.0 months, against 13.8 months for the 143 patients under 20%.
  • Multivariate analysis: nonepithelial subtype (55 patients) was associated with a 1.52-fold increased mortality rate compared with epithelial subtype (100 patients) (95% CI 1.07 to 2.31, P = 0.022). Median survival was 12.30 months for nonepithelial and 14.70 months for epithelial.
  • Neither analysis found a significant association between survival time and any of the following, at the cut-offs used:
• platelet-to-lymphocyte ratio of 300 or more
• mean platelet volume of 8 fl or more
• LDH of 500 U/l or more
• high platelet count
• high white cell count
• haemoglobin level
  • Patients with NLR 3 or more, compared with NLR under 3, more often had:
• nonepithelial subtype: 31 (46.3%) vs 21 (25.6%), P = 0.007
• white cell count of 11 200 or more: 12 (17.9%) vs 0
• platelet-to-lymphocyte ratio of 300 or more: 14 (20.9%) vs 4 (4.9%), P = 0.003
  • Among patients with RDW 20% or more, all 9 had epithelial subtype, compared with 90 of 143 (62.9%) with RDW under 20% (P = 0.018). High platelet count was found in 5 of 9 (55.6%) vs 27 (18.9%) (P = 0.021).
• The authors' conclusion: The authors concluded that NLR and RDW were significant predictive factors for malignant mesothelioma prognosis. They suggested that these inexpensive blood-count measures may help in choosing between aggressive and palliative treatment.
• Limitations the authors state:
  • The study was retrospective and used pretreatment information from patient files. Treatment regimens and their outcomes were unavailable because patients were managed in other clinics.
  • Patient data did not consistently include disease stage, comorbidities, performance status, chest pain or treatment regimens.
  • The authors learned of the REMARK reporting guidelines for tumour marker studies only after the study was done.
  • There were too few peritoneal and pericardial cases for statistical analysis.

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: Prognosis, Mesothelioma, Inflammation, Asbestos Exposure, Median Overall Survival, Multivariate Analysis.

Related studies

• Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2016)
• The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma — W. Yin, G. Zheng, et al. (2019)
• Health-related quality of life and inflammatory markers in malignant pleural mesothelioma — S.C. Kao, J. Vardy, et al. (2013)
• Methylation-derived Neutrophil-to-Lymphocyte Ratio and Lung Cancer Risk in Heavy Smokers — L. Grieshober, S. Graw, et al. (2018)
• Malignant Peritoneal Mesothelioma: Characterization of the Inflammatory Response in the Tumor Microenvironment — S. Judge, P. Thomas, et al. (2016)
• Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2017)

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