A Promising Prognostic Indicator for Pleural Mesothelioma: Pan-Immuno-Inflammation Value

Our plain-English summary of A Promising Prognostic Indicator for Pleural Mesothelioma: Pan-Immuno-Inflammation Value, by S. Yaşar, F. Yılmaz, Ö.D. Tatar, et al (Journal of Clinical Medicine, 2025).

The study

• Authors: S. Yaşar, F. Yılmaz, Ö.D. Tatar, H.Ç. Yıldırım, Z. Arık, Ş. Yalçın, M. Erman
• Journal: Journal of Clinical Medicine
• Published: 2025;14(15)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma (PM) is a type of cancer that is difficult to diagnose and treat. Patients may have vastly varying prognoses, and prognostic factors may help guide the clinical approach. As a recently identified biomarker, the pan-Immune-Inflammation-Value (PIV) is a simple, comprehensive, and peripheral blood cell-based biomarker. Methods: The present study represents a retrospective observational analysis carried out within a single-center setting. Ninety-five patients with PM stages I-IV were enrolled in the study. We analyzed the correlation between patients' demographic characteristics, clinicopathological factors such as histological subtypes, surgery status, tumor thickness, blood-based parameters, and treatment options with their prognoses. PIV was calculated by the following formula: (neutrophil count × monocyte count × platelet count)/lymphocyte count. Additionally, blood-based parameters were used to calculate the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII). Results: We categorized the patients into two groups, low PIV group (PIV ≤ 732.3) and high PIV group (PIV > 732.3) according to the determined cut-off value, which was defined as the median. It was revealed that high PIV was associated with poor survival outcomes. The median follow-up period was 15.8 months (interquartile range, IQR, 7.1 to 29.8 months). The median overall survival (OS) was significantly longer in patients in the low PIV group (median 29.8 months, 95% confidence interval (CI), 15.6 to 44) than the high PIV group (median 14.7 months, 95% CI, 10.8 to 18.6 p < 0.001). Furthermore, the study revealed that patients with low PIV, NLR, and SII values were more likely to be eligible for surgery and were diagnosed at earlier stages. Additionally, these markers were identified as potential predictors of disease-free survival (DFS) in the surgical cohort and of treatment response across the entire patient population. Conclusions: In addition to well-established clinical factors such as stage, histologic subtype, resectability, and Eastern Cooperative Oncology Group (ECOG) performance status (PS), PIV emerged as an independent and significant prognostic factor of overall survival (OS) in patients with PM. Moreover, PIV also demonstrated a remarkable independent prognostic value for disease-free survival (DFS) in this patient population. Additionally, some clues are provided for conditions such as treatment responses, staging, and suitability for surgery. As such, in this cohort, it has outperformed the other blood-based markers based on our findings. Given its ease of calculation and cost-effectiveness, PIV represents a promising and practical prognostic tool in the clinical management of pleural mesothelioma. It can be easily calculated using routinely available laboratory parameters for every cancer patient, requiring no additional cost or complex procedures, thus facilitating its integration into everyday clinical practice.

In plain English

This retrospective study at one Turkish center studied 95 adults with stage I to IV pleural mesothelioma seen from 2014 to 2021. It did not examine asbestos exposure. Patients were split at the median (732.3) of a pretreatment blood-count score, the pan-immune-inflammation value (PIV). Median overall survival was 29.8 months (95% CI 15.6 to 44) with low PIV and 14.7 months (95% CI 10.8 to 18.6) with high PIV. In adjusted analysis, high PIV (hazard ratio 3.35, 95% CI 1.29 to 8.76) and non-epithelioid tumor type (hazard ratio 2.46, 95% CI 1.20 to 5.05) were independently associated with poorer survival. Among 29 surgical patients, median disease-free survival was 18.8 months (95% CI 6.2 to 31.3) with low PIV and 7.4 months (95% CI 0 to 16.8) with high PIV. Without surgery, the difference in median overall survival, 20.2 months (95% CI 5.8 to 34.6) versus 14.7 months (95% CI 10.4 to 18.9), was not statistically significant. The authors concluded PIV may help predict outcome, pending further studies. They noted limited sample size, short follow-up and no external validation.

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 observational single-center study of medical records
• Who was studied: 95 patients over 18 years old with histologically or cytologically confirmed pleural mesothelioma, stages I to IV, admitted to Hacettepe University Cancer Center (Ankara, Turkey) between January 2014 and January 2021. 63.2% were male, the median age was 62, and 68.4% had epithelioid histology. 29 patients underwent surgery.
• Exposure: Not an asbestos exposure study. The factor studied was the pretreatment pan-immune-inflammation value (PIV = neutrophil count times platelet count times monocyte count, divided by lymphocyte count), compared with NLR, PLR and SII. Patients were split into low and high groups at the median PIV of 732.3.
• Main results:
  • All 95 patients: median overall survival was 29.8 months (95% CI 15.6 to 44) in the low PIV group and 14.7 months (95% CI 10.8 to 18.6) in the high PIV group, p less than 0.001. Median follow-up was 15.8 months.
  • All patients: lower NLR and lower SII were associated with longer survival (p = 0.016 and p = 0.037). PLR was not statistically significant for overall survival (p = 0.125).
  • Multivariate analysis, all patients: high PIV (HR 3.35, 95% CI 1.29 to 8.76, p = 0.013) and non-epithelioid type (HR 2.46, 95% CI 1.2 to 5.05, p = 0.013) were independently associated with poor survival.
  • Excluding stage IV patients: 77.5% of the high PIV group were not suitable for surgery, compared with 55.3% of the low PIV group.
  • Stage at diagnosis: 66.7% of the high PIV group were stage III to IV, compared with 44% of the low PIV group.
  • Surgical group: median overall survival was not reached in the low PIV group and was 14.3 months (95% CI 0.9 to 34.1) in the high PIV group (p less than 0.001). In the low PIV group, 1-year survival was 77% and 3-year survival 67%. In the high PIV group, 1-year survival was 60% and no patient survived more than 3 years.
  • Surgical group (29 patients): median disease-free survival was 18.8 months (95% CI 6.2 to 31.3) in the low PIV group and 7.4 months (95% CI 0 to 16.8) in the high PIV group (p = 0.021).
  • Non-surgical group: median overall survival was 20.2 months (95% CI 5.8 to 34.6) with low PIV and 14.7 months (95% CI 10.4 to 18.9) with high PIV. The p-value of 0.059 did not reach the study's p less than 0.05 threshold.
• The authors' conclusion: The authors concluded that PIV is a simple, inexpensive, non-invasive biomarker that can help better predict the outcome of pleural mesothelioma patients, and that it could become a useful prognostic tool if further studies support its role.
• Limitations the authors state:
  • The study was conducted at a single center, the sample size was limited, and follow-up was relatively short.
  • The results were not validated in an external group.
  • The effect of PIV on treatment outcomes was not evaluated, so it cannot be used as a predictive marker.
  • The number of patients in the surgical group was limited.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Inflammation, Biomarker, Histological Subtype, Median Overall Survival, confidence interval, Disease-Free Survival, Performance Status.

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• Inflammation-based prognostic indices in malignant pleural mesothelioma — D.J. Pinato, F.A. Mauri, et al. (2012)

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