Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio reliable parameters as prognostic indicators in malignant mesothelioma?

Our plain-English summary of Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio reliable parameters as prognostic indicators in malignant mesothelioma?, by S. Tural Onur, S.N. Sokucu, L. Dalar, et al (Therapeutics and Clinical Risk Management, 2016).

The study

• Authors: S. Tural Onur, S.N. Sokucu, L. Dalar, S. Iliaz, K. Kara, S. Buyukkale, S. Altin
• Journal: Therapeutics and Clinical Risk Management
• Published: 2016;12:651-6
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma (MM) is an aggressive asbestos-related pleural tumor. The incidence is increasing with intensive use of asbestos in developing countries. We need an easily accessible, inexpensive, and reliable method for determining the low survival time prognosis of this tumor. The aim of our study was to investigate the viability of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as prognostic indicators in MM.

Patients And Methods: Thirty-six patients with MM, whose histopathologic diagnosis and follow-up were performed by our clinic and whose complete archive data were accessible, were included in this retrospective study. The patients' histopathologic disease types and stages, complete blood count parameters at diagnosis, and survival were recorded.

Results: Eighteen of the patients with MM were male and the remaining 18 of them were female; the average follow-up period was 24.83±3.61 months. The PLR levels of the patients were statistically significant (P<0.05). The NLR and PLR area under the receiver operating characteristic curve values were 0.559 and 0.749, respectively (P=0.631 and P=0.044, respectively).

Conclusion: PLR was a significant prognostic indicator of MM at diagnosis on complete blood count parameters; however, NLR was not a significant prognostic indicator. A large number of prospective studies are needed to prove the reliability of the parameters.

In plain English

This retrospective study from a chest diseases hospital in Istanbul, Turkey, asked whether two ratios from a routine blood count taken at diagnosis could predict survival in malignant mesothelioma. The two ratios were the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR). The authors reviewed the records of 36 patients (18 men and 18 women, aged 33 to 89) diagnosed by pleural biopsy. Of these, 32 (88.8%) had lived in areas of Turkey with endemic asbestosis. By the time of the review, 29 patients had died and 7 were alive, and mean survival was 24.83 months. Patients who died were significantly older. NLR did not differ significantly between patients who died and those who survived. In an area-under-the-curve analysis, PLR scored 0.749 (P=0.044). NLR scored 0.599 in the main text but 0.559 in the abstract. The article's own table comparing PLR between survivors and patients who died gave P=0.622. The authors concluded that PLR was a significant prognostic indicator and NLR was not. They added that it was too early to replace existing scoring systems and that large prospective studies were needed.

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 archive records (single center)
• Who was studied: 36 patients with histopathologically diagnosed malignant mesothelioma (18 male, 18 female; age 33 to 89 years, mean 58.36) diagnosed after investigation of exudative pleural fluid at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; records examined January to September 2014. Most tumors were epithelioid (29 of 36).
• Exposure: The factors studied were blood count ratios (NLR and PLR) measured at diagnosis, not asbestos exposure. As background, 32 of 36 patients (88.8%) had lived in areas of endemic asbestosis in Turkey. No fiber types or doses are reported.
• Main results:
  • Of the 36 patients, 29 died and 7 were alive; mean survival time was 24.83 plus or minus 3.61 months.
  • Patients who died were significantly older than those who survived (P less than 0.05); there was no significant difference in mortality by sex.
  • NLR, red blood cell distribution width (RDW) and mean platelet volume (MPV) did not differ significantly between patients who died and those who survived.
  • Area under the ROC curve was 0.749 for PLR. For NLR the main text gives 0.599, while the abstract gives 0.559. The abstract reports P=0.631 for NLR and P=0.044 for PLR.
  • In the table comparing laboratory findings by mortality (Mann-Whitney U-test), median PLR was 190.49 in survivors and 219.73 in patients who died, P=0.622.
  • The cutoff value for PLR was 158.
• The authors' conclusion: The authors concluded that PLR at diagnosis was a statistically significant prognostic indicator in malignant mesothelioma and NLR was not. They added that it was too early to replace scoring systems such as EORTC and CALGB, and that large-scale prospective studies were needed.
• Limitations the authors state:
  • The study was retrospective, and only a single blood count at diagnosis was used rather than ratios at different disease stages.
  • Few patients had comprehensive data; patients were not randomized to treatment, and treatment protocols were not included.
  • The center is diagnostic only; most patients were treated elsewhere, and EORTC and CALGB stages and treatment were not available.
  • The authors suggested the lack of significance for NLR may reflect the small sample size and different cutoff values.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Prognosis.

Related studies

• High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy — S.C. Kao, N. Pavlakis, et al. (2010)
• Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy — S.C. Kao, S. Klebe, et al. (2011)
• Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma — T.M. Meniawy, J. Creaney, et al. (2013)
• Prognostic significance of neutrophil-to-lymphocyte ratio in patients with malignant pleural mesothelioma: a meta-analysis — N. Chen, S. Liu, et al. (2017)
• Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression — L. Gutierrez-Sainz, P. Cruz, et al. (2021)
• Comment on 'Existing prognostic models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma' — S.C. Kao, N. van Zandwijk, et al. (2014)

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