Prognostic factors and the prognostic role of inflammation indices in malignant pleural mesothelioma

Our plain-English summary of Prognostic factors and the prognostic role of inflammation indices in malignant pleural mesothelioma, by S. Ebinç, Z. Oruç, Z. Kalkan, et al (Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2023).

The study

• Authors: S. Ebinç, Z. Oruç, Z. Kalkan, O. Karhan, Z. Urakçı, M. Küçüköner, M.A. Kaplan, I. Abdurrahman
• Journal: Türk Göğüs Kalp Damar Cerrahisi Dergisi
• Published: 2023;31(1):105-115
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In this study, we aimed to investigate the prognostic factors of malignant pleural mesothelioma and the prognostic value of inflammation indices in malignant pleural mesothelioma.

Methods: Between January 2002 and December 2019, a total of 132 patients (74 males, 58 females; mean age: 55 years; range, 31 to 79 years) diagnosed with malignant pleural mesothelioma were retrospectively analyzed. Patients" demographic data and laboratory results were recorded. The prognostic value of the following five inflammation indices was evaluated: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, advanced lung cancer inflammation index, C-reactive protein/albumin ratio, and prognostic nutritional index.

Results: Of all patients, 81% (n=107) were aged 65 or older and 61.4% (n=81) had an epithelioid histology. Of 12 variables examined in the multivariate analysis for their relationship with survival, age ≥65 years, non-epithelioid subtype, and prognostic nutritional index <40 were found to be poor prognostic factors. Based on the score constructed from these factors, the good prognostic group (score 0-1) had a median overall survival of 21 months and a one-year survival rate of 77.9%, while the poor prognostic group (score 2-3) had a median overall survival of nine months and a one-year survival rate of 29.7%.

Conclusion: Our study results indicate that age ≥65 years, prognostic nutritional index <40, and non-epithelioid histological subtype are poor prognostic factors of malignant pleural mesothelioma.

Copyright © 2023, Turkish Society of Cardiovascular Surgery.

In plain English

This single-center, retrospective study reviewed 132 patients (74 men, 58 women) diagnosed with malignant pleural mesothelioma at Dicle University in Diyarbakır, Türkiye, between January 2002 and December 2019. The authors tested whether age, sex, performance status, tumor subtype, blood counts and five blood-based inflammation indices were linked to overall survival. Asbestos exposure was not analyzed. In the multivariate analysis, three factors were associated with shorter survival: age 65 or older (hazard ratio 1.87; 95% CI 1.18-2.96), non-epithelioid tumor subtype (1.79; 1.23-2.59), and a prognostic nutritional index below 40 (1.62; 1.11-2.36). This index is calculated from blood albumin and lymphocyte count. The other four indices were not statistically significantly linked to survival. Under a score giving one point per factor, the 95 patients with 0-1 points had a median survival of 21 months and one-year survival of 77.9%. The 37 patients with 2-3 points had 9 months and 29.7%. The authors concluded the score may be a simple, useful tool. They noted the single-center retrospective design, heterogeneous patient groups, and relatively few patients aged 65 or older.

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-center retrospective study of patient records (survival analysis with Cox regression)
• Who was studied: 132 patients (74 male, 58 female; age 55 years, range 31 to 79) diagnosed with malignant pleural mesothelioma at Dicle University Faculty of Medicine, Medical Oncology Clinic, Diyarbakır, Türkiye, January 2002 to December 2019. All received at least one line of chemotherapy, 42 had surgery and 60 had radiotherapy.
• Exposure: Asbestos exposure was not recorded or analyzed. The factors studied were age, sex, ECOG performance status, histological subtype, white blood cell count, platelet count, hemoglobin, and five inflammation indices measured at diagnosis: prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein/albumin ratio.
• Main results:
  • In the multivariate analysis, age 65 or older (HR 1.87; 95% CI 1.18-2.96, p=0.007) and non-epithelioid histology (HR 1.79; 95% CI 1.23-2.59, p=0.002) were associated with poor survival. Median overall survival was 19 months in patients younger than 65 and 11 months in those 65 or older. It was 22 months for epithelioid and 11 months for non-epithelioid histology.
  • A prognostic nutritional index below 40 was associated with poor survival in the multivariate analysis (HR 1.62; 95% CI 1.11-2.36, p=0.012). Median overall survival was 21 versus 12 months for the higher and lower PNI groups. One-year survival was 74.4% with PNI 40 or above versus 48% with PNI below 40 (p=0.002).
  • The ALB/CRP ratio, NLR, PLR and ALI did not have a statistically significant relationship with survival.
  • Sex, ECOG performance status, white blood cell count, platelet count and hemoglobin level at diagnosis did not have a statistically significant relationship with prognosis.
  • Under the three-factor score, the good prognostic group (score 0-1, n=95) had a median overall survival of 21 months and one-year survival of 77.9%. The poor prognostic group (score 2-3, n=37) had 9 months and 29.7% (HR 3.09, 95% CI 2.05-4.65, p less than 0.001).
  • Among the indices, PNI correlated strongly and positively with ALI (r=0.733), and ALI correlated strongly and negatively with NLR (r=-0.920).
• The authors' conclusion: The authors concluded that a prognostic nutritional index below 40, age 65 or older, and non-epithelioid histology are poor prognostic factors. They stated that the resulting score may serve as a simple and useful system for predicting malignant pleural mesothelioma prognosis in clinical practice.
• Limitations the authors state:
  • Single-center, retrospective design
  • Heterogeneity of the patient groups
  • Relatively low number of patients aged 65 or older

Topics

Medical terms in this study, explained in our Lexicon: Inflammation, Pleural Mesothelioma, Lung Cancer, Epithelioid, Histology, Multivariate Analysis, Non-epithelioid, Median Overall Survival.

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