Prognostic Significance of Blood, Serum, and Ascites Parameters in Patients with Malignant Peritoneal Mesothelioma or Peritoneal Carcinomatosis

Our plain-English summary of Prognostic Significance of Blood, Serum, and Ascites Parameters in Patients with Malignant Peritoneal Mesothelioma or Peritoneal Carcinomatosis, by S.S. Su, G.Q. Zheng, W.J. Yin, et al (Gastroenterology Research and Practice, 2018).

The study

• Authors: S.S. Su, G.Q. Zheng, W.J. Yin, Y.F. Liang, Y.Y. Liu, H. Song, N.N. Sun, Y.X. Yang
• Journal: Gastroenterology Research and Practice
• Published: 2018;2018:2619526
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

To determine effects of the biochemical and cytological properties of blood, serum, and ascites on survival of patients with malignant peritoneal effusion (MPeE), including malignant peritoneal mesothelioma (MPeM) and peritoneal carcinomatosis (PC), we conducted a retrospective study of patients with MPeE and healthy controls. Potential prognostic factors were identified as follows: age, sex, blood neutrophil-to-lymphocyte ratio (NLR), serum parameters, ascites parameters, serum-ascites albumin gradient, and the ascites-serum LDH ratio. Compared to those of the control group, serum albumin levels were significantly lower, and the NLR and serum LDH levels were significantly higher in the MPeE group. Overall survival (OS) was longer in patients with MPeM compared to that in patients with PC. Compared with patients in the MPeM, patients with PC had higher NLRs, ascites glucose levels, serum-ascites albumin gradients, and serum LDH levels. In contrast, their ascites albumin levels and ascites-serum LDH ratios were lower. Univariate analyses indicated that the NLR, serum LDH levels, ascites LDH levels, ascites coenocyte levels, and the ascites coenocyte-to-monocyte ratios affected the OS. Multivariate analyses identified only serum and ascites LDH levels as independent prognostic factors.

In plain English

This retrospective study from Cangzhou Central Hospital in China looked at 125 patients with cancer-related fluid in the abdomen (malignant peritoneal effusion) treated from January 2012 to January 2017. Of these, 43 had malignant peritoneal mesothelioma and 82 had peritoneal carcinomatosis, meaning cancer spread to the abdominal lining. Thirty-two age- and gender-matched healthy people served as controls. The authors examined whether blood, serum and abdominal fluid (ascites) measurements were linked to survival. The article did not report on asbestos exposure. Median survival was 8 months overall, 11 months for the mesothelioma patients and 7.5 months for the carcinomatosis patients, a statistically significant difference. In single-factor analyses, shorter survival was linked to five measures: higher levels of the enzyme LDH (lactate dehydrogenase) in serum or in ascites, a higher blood neutrophil-to-lymphocyte ratio, a higher percentage of ascites "coenocytes" and a higher ascites coenocyte-to-monocyte ratio. In the multivariate analysis, only serum and ascites LDH levels remained independent prognostic factors. The authors concluded that these LDH levels predicted survival. They listed small numbers in some categories, mixed tumor types and the retrospective design 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 patients' records (survival and prognostic-factor analysis) with healthy controls
• Who was studied: 125 patients hospitalized with malignant ascites at Cangzhou Central Hospital, Hebei, China, January 2012 to January 2017: 43 with diffuse malignant peritoneal mesothelioma and 82 with peritoneal carcinomatosis, plus 32 age- and gender-matched healthy controls
• Exposure: Not studied. The article examined blood, serum and ascites measurements as predictors of survival and does not report asbestos or other fiber exposure.
• Main results:
  • Median overall survival was 8 months (range 1 to 42) for all 125 patients. For peritoneal mesothelioma patients it was 11 months (range 1 to 42), compared with 7.5 months for peritoneal carcinomatosis patients (P = 0.034, per Table 3).
  • Compared with the 32 healthy controls, the 125 patients had significantly lower serum albumin (34.69 ± 5.15 vs 47.51 ± 4.21 g/L, P less than 0.001) and higher serum LDH (median 210.5 vs 179.0 U/L, P = 0.020).
  • Mesothelioma patients had a lower serum-ascites albumin gradient than carcinomatosis patients (6.74 ± 3.32 vs 10.06 ± 4.18 g/L, P = 0.002). They also had a higher ascites-serum LDH ratio (median 2.00 vs 1.05, P = 0.004) and lower serum LDH (median 191 vs 248 U/L, P = 0.046).
  • In single-factor (Kaplan–Meier) analysis of all 125 patients, shorter survival was associated with higher ascites LDH and higher serum LDH. Median survival was 7.0 vs 14.0 months for ascites LDH at or above 299 vs below 299 U/L (P = 0.015). It was 7.0 vs 14.0 months for serum LDH at or above 210.5 vs below 210.5 U/L (P = 0.008).
  • In single-factor analysis, shorter survival was also associated with a higher blood neutrophil-to-lymphocyte ratio (P = 0.027), a higher percentage of ascites coenocytes (30% or more vs under 30%, P = 0.023) and a higher ascites coenocyte-to-monocyte ratio (P = 0.019). None of these was significant in the Cox analysis.
  • In multivariate Cox analysis, ascites LDH (P = 0.023) and serum LDH (P = 0.037) were independent prognostic factors for survival. No hazard ratios are printed.
  • Serum albumin, ascites albumin, ascites glucose, the serum-ascites albumin gradient, sex and age were not significantly associated with survival.
• The authors' conclusion: The authors concluded that serum and ascites LDH levels were independent predictors of survival in patients with malignant peritoneal effusion. They also concluded that survival was significantly longer with peritoneal mesothelioma than with peritoneal carcinomatosis.
• Limitations the authors state:
  • Small sample size in some categories
  • Broad inclusion criteria and heterogeneity among patients with different primary tumors
  • Retrospective design with inherent bias
  • Univariate analysis may overestimate effect size
  • Only commonly used clinical parameters were examined

Topics

Medical terms in this study, explained in our Lexicon: Ascites, Peritoneal Mesothelioma, Overall Survival.

Related studies

• Malignant peritoneal mesothelioma: prognostic significance of clinical and pathologic parameters and validation of a nuclear-grading system in a multi-institutional series of 225 cases — D.B. Chapel, J.J. Schulte, et al. (2021)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis — Y.F. Liang, G.Q. Zheng, et al. (2016)
• Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC — E. Halkia, A. Tsochrinis, et al. (2015)
• Malignant Peritoneal Mesothelioma Presenting with High Protein, High Serum-Ascites Albumin Gradient — Z.P. Kerosky, C.R. Powell, et al. (2022)
• Evaluation of prognostic histological parameters proposed for pleural mesothelioma in diffuse malignant peritoneal mesothelioma. A short report — F. Pezzuto, L. Vimercati, et al. (2021)

Browse more research in Gastroenterology Research and Practice, or return to medical research.