Prognostic effect of systemic inflammation in patients undergoing cytoreductive surgery and hyperthermic intrathoracic chemotherapy

Our plain-English summary of Prognostic effect of systemic inflammation in patients undergoing cytoreductive surgery and hyperthermic intrathoracic chemotherapy, by A.K. Tekneci, H. Yavuz, G. Keçeci Özgür, et al (Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2026).

The study

• Authors: A.K. Tekneci, H. Yavuz, G. Keçeci Özgür, T.İ. Akçam, A.G. Ergönül, K. Turhan, A. Çakan, U. Çağırıcı
• Journal: Türk Göğüs Kalp Damar Cerrahisi Dergisi
• Published: 2026;34(2):192-197
• Read it: PubMed · Publisher · Free full text

Abstract

Background: To investigate prognostic significance of systemic inflammation-related parameters in patients undergoing cytoreductive surgery and hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma (MPM).

Methods: Data from 55 patients were analyzed retrospectively. Demographic characteristics, survival outcomes and inflammation-related parameters (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], lymphocyte/monocyte ratio [LMR] and pan-immune inflammation value [PIV]) were evaluated.

Results: Overall survival (OS) was 61.26±13.03 (3-79) months in patients with low NLR, whereas, it was 23.18±3.53 (1-147) months in patients with high NLR (p=0.012). No statistically significant differences in OS were detected according to LMR, PLR and PIV. In addition, OS was 24.40±4.91 (3-92) months in men and 52.8±10.92 (1-147) months in women (p=0.031).

Conclusion: In this study, NLR was found to be associated with survival in agreement with the existing literature, thereby distinguishing it from other inflammatory markers as a prognostic factor. In clinical practice, predicting patient prognosis based on pre-treatment NLR may provide a valuable guidance for treatment decision-making.

Copyright© 2026 The Author(s). Published by Galenos Publishing House on behalf of Turkish Society of Cardiovascular Surgery and Turkish Thoracic Surgery Association.

In plain English

This retrospective study looked at 55 patients with malignant pleural mesothelioma who had cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy (heated cisplatin circulated through the chest) between September 2008 and December 2022. The authors asked whether blood-count measures of inflammation, taken the day before surgery, were linked to survival. The article did not report asbestos-exposure measurements. Patients with a neutrophil/lymphocyte ratio (NLR) of 3 or higher had a mean overall survival of 23.18 months, against 61.26 months for those below 3 (p=0.012), and a higher share of them died (83.3% vs. 56%). Three other inflammation measures (PLR, LMR and the pan-immune inflammation value) showed no statistically significant survival differences. Men had a mean survival of 24.40 months and women 52.8 months (p=0.031). In a combined analysis, high NLR (hazard ratio 2.36, 95% CI 1.21-4.62) and male gender (hazard ratio 2.12, 95% CI 1.09-4.13) were each associated with a higher risk of death. The authors concluded that pre-treatment NLR was associated with survival and may help guide treatment decisions. They named the single-centre design and small sample as limitations.

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 records (single-centre, per the authors), with Kaplan-Meier survival analysis and multivariate Cox regression
• Who was studied: 55 patients with malignant pleural mesothelioma (MPM) treated with cytoreductive surgery and HITHOC between September 2008 and December 2022, out of 85 treated. Ethics approval came from Ege University, Türkiye. The authors excluded patients with sarcomatoid histology, induction therapy, a different postoperative chemotherapy protocol, or conditions affecting inflammation. Mean age was 58.67 years and 27 were male. 50 tumours were epithelioid and 5 biphasic, and all were early stage.
• Exposure: The article did not report asbestos-exposure measurements; asbestos is mentioned only in the introduction as a known cause of MPM. The factors studied were inflammation markers calculated from a blood count taken the day before surgery: NLR, PLR, LMR and PIV. Cut-offs were taken from the literature: NLR 3, LMR 3, PLR 149 for males and 172 for females, and the median PIV of 513.92. All patients received the same treatment, cisplatin 100 mg/m2 perfused into the chest at 40 to 42 °C for 60 minutes after surgery.
• Main results:
  • In patients with high preoperative NLR (3 or higher), mortality was 83.3%, against 56% in patients with low NLR (p=0.026). Mean overall survival was 61.26 months with low NLR and 23.18 months with high NLR (p=0.012).
  • Overall survival did not differ to a statistically significant degree by LMR (39.01 vs 40.97 months, p=0.351), PLR (45.19 vs 36.13 months, p=0.148) or PIV (40.63 vs 38.28 months, p=0.370).
  • Mean overall survival was 24.40 months in men and 52.8 months in women (p=0.031).
  • In multivariate Cox regression, male gender (HR=2.12, 95% CI 1.09-4.13, p=0.028) and high NLR (HR=2.36, 95% CI 1.21-4.62, p=0.012) were each associated with increased mortality risk.
  • At the time of the study, 39 of the 55 patients (70.9%) had died.
  • ROC analysis did not give statistically significant cut-off values for any of the four markers, so cut-offs from the literature were used.
• The authors' conclusion: The authors concluded that NLR was associated with survival, in general agreement with the literature, which set it apart from the other inflammatory markers as a prognostic factor. They wrote that predicting prognosis from pre-treatment NLR could help decide on treatment, on the need for adjuvant treatment, and on follow-up.
• Limitations the authors state:
  • The retrospective, single-centre design may limit how far the findings apply to other institutions and patient groups.
  • The relatively small sample may have reduced statistical power, particularly for the non-significant findings, and limited how many potential confounders could be included in the model.
  • ROC analysis could not identify study-specific cut-off values, so thresholds from the literature were used.

Topics

Medical terms in this study, explained in our Lexicon: Inflammation, Cytoreductive Surgery, Intrathoracic, Chemotherapy, Pleural Mesothelioma, Overall Survival, Prognosis.

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• Utility of Chemoresponse Assay in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy — S. Bhagwandin, S. Naffouje, et al. (2015)
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• Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma — E. de Bree, S. van Ruth, et al. (2002)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)

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