High systemic immune-inflammation index represents an unfavorable prognosis of malignant pleural mesothelioma

Our plain-English summary of High systemic immune-inflammation index represents an unfavorable prognosis of malignant pleural mesothelioma, by M. Ma, N. Yu, B. Wu (Cancer Management and Research, 2019).

The study

• Authors: M. Ma, N. Yu, B. Wu
• Journal: Cancer Management and Research
• Published: 2019;11:3973-3979
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) represents a fatal disease with high aggressiveness, and limited biomarkers have yet been identified for MPM. The present study aims to explore potential serum prognostic factors of MPM. Materials and methods: A retrospective analysis of 97 pathologically diagnosed MPM was performed. The optimal cutoff value of pretreatment systemic immune-inflammation index (SII) was determined by receiver operating characteristic curve. Kaplan-Meier curves and Cox regression analysis were performed to assess the potential prognostic roles of parameters. Results: A total of 59.8% (n=58) patients are male, with a median age of 56.0 years (range 18-77). The optimal cutoff value of SII was 988.6×109/L. High and low SII were found in 44 (45.4%) and 53 (54.6%) patients, respectively. Median survival time for total 97 cases was 18.5 months. The median overall survival for patients with low and high SII was 47.0 and 13.0 months, respectively. The 1-, 2- and 3-year survival rates for patients with low SII were 85.8%, 57.8% and 52.0% compared to that of 53.9%, 23.6% and 13.8% in patients with high SII. On univariate analysis, Eastern Cooperative Oncology Group performance status (ECOG PS)<2 points, low SII and adjuvant treatment (P<0.05) were found to be closely correlated with a better prognosis of MPM. Only ECOG PS (P=0.036) and SII (P=0.009) held statistical significance on multivariate analysis. Conclusion: Pretreatment SII is easy to access to, and it represents an efficiency and noninvasive biomarker of MPM. High SII represents an unfavorable independent prognostic factor of MPM, and this needs to be validated in further studies.

In plain English

This retrospective study reviewed the records of 97 patients with pathologically diagnosed malignant pleural mesothelioma treated at Linyi People's Hospital in China between April 2003 and December 2015. The authors asked whether a blood measure taken before treatment was linked to survival. The measure was the systemic immune-inflammation index (SII), calculated as neutrophil count times platelet count divided by lymphocyte count. They used a cutoff of 988.6 × 10^9/L. Median overall survival for all patients was 18.5 months. The 44 patients with low SII had a median survival of 47.0 months, compared with 13.0 months for the 53 patients with high SII. After adjusting for the other factors studied, two factors remained linked to shorter survival: high SII (hazard ratio 2.298, 95% CI 1.232 to 4.289) and poorer performance status, meaning an ECOG score of 2 or more, which applied to only 6 patients. The authors concluded that high pretreatment SII is an unfavorable independent prognostic factor and that this needs confirmation in further studies. They noted that this was a single-hospital study with limited numbers, and that information on asbestos exposure, tumor histology and stage was not available.

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: Single-institution retrospective study of survival (prognostic factor analysis)
• Who was studied: 97 patients with pathologically diagnosed malignant pleural mesothelioma at Linyi People's Hospital, China, April 2003 to December 2015. 58 men (59.8%) and 39 women (40.2%), median age 56.0 years (range 18 to 77).
• Exposure: Not an asbestos exposure study. The factor studied was the pretreatment systemic immune-inflammation index (neutrophil × platelet / lymphocyte counts), split at 988.6 × 10^9/L. Asbestos exposure was not recorded or evaluated.
• Main results:
  • Median overall survival for all 97 patients was 18.5 months.
  • Median overall survival was 47.0 months for patients with low pretreatment SII (n=44) and 13.0 months for patients with high SII (n=53).
  • 1-, 2- and 3-year survival was 85.8%, 57.8% and 52.0% for low-SII patients, and 53.9%, 23.6% and 13.8% for high-SII patients.
  • On multivariate analysis, high pretreatment SII (988.6 × 10^9/L or more) was independently associated with shorter survival: HR 2.298 (95% CI 1.232 to 4.289), P=0.009.
  • On multivariate analysis, ECOG performance status of 2 or more (6 patients) was independently associated with shorter survival: HR 3.573 (95% CI 1.085 to 11.765), P=0.036.
  • On univariate analysis, median survival was 2.3 months with best supportive care (n=15) and 21.5 months with adjuvant therapies (n=82), P=0.003. In the multivariate analysis treatment did not reach significance (HR 0.467, 95% CI 0.201 to 1.085, P=0.077 per Table 1).
  • Low SII was more common in patients with weight loss (66.7%) than without weight loss (40.5%), P=0.044. No significant association was found between SII and age, gender, smoking history, ECOG score, tumor side or pleural effusion.
• The authors' conclusion: The authors concluded that high pretreatment SII is an unfavorable independent prognostic factor in malignant pleural mesothelioma, and that this needs to be validated in further studies.
• Limitations the authors state:
  • Single-institution retrospective study with a limited number of patients.
  • Histological type, asbestos exposure and TNM stage were not available and were not evaluated, including any link between SII and histology or asbestos exposure.
  • No healthy control group was included.

Topics

Medical terms in this study, explained in our Lexicon: Inflammation, Prognosis, Pleural Mesothelioma, Biomarker, Kaplan-Meier Curve, Median Overall Survival, Performance Status, Statistical Significance.

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