Prognostic significance of inflammation-related and electrolyte laboratory variables in patients with malignant pleural mesothelioma

Our plain-English summary of Prognostic significance of inflammation-related and electrolyte laboratory variables in patients with malignant pleural mesothelioma, by Y. Zhang, J. Li, S. Zhang (Frontiers in Medicine, 2023).

The study

• Authors: Y. Zhang, J. Li, S. Zhang
• Journal: Frontiers in Medicine
• Published: 2023;10:1099685
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Malignant pleural mesothelioma (MPM) is a kind of pleural cancer characterized by low incidence but high invasiveness. There is heterogeneity in survival among patients with MPM. Inflammation-related and electrolyte laboratory variables were previously reported as potential predictors of survival. We evaluated the relationship between overall survival and pre-treatment biomarkers.

Materials And Methods: Patients diagnosed with MPM in Beijing Chaoyang Hospital for more than 10 years were screened for this study. All basic, clinical, radiologic and laboratory variables were collected. The COX univariable and multivariable analysis were used to explore prognostic related risk factors.

Results: Ninety patients with MPM were included. The median follow-up of all patients was 57 months [interquartile range (IQR): 27-100 months]. The median survival time was 24 months (IQR: 12-52 months). Univariate survival analyses indicated that age, Eastern Cooperative Oncology Group Performance Status, treatment, erythrocyte sedimentation rate, calcium, lymphocyte, hemoglobin, platelet-to-lymphocyte ratio (PLR), and monocyte-to-white blood cell ratio (MWR) were significantly related to survival. Multivariable analysis demonstrated that age [hazard ratio (HR), 2.548; 95% confidence interval (CI) 1.145-5.666; p = 0.022], calcium (HR, 0.480; 95% CI 0.270-0.855; p = 0.013), PLR (HR, 2.152; 95% CI 1.163-3.981; p = 0.015), and MWR (HR, 3.360; 95% CI 1.830-6.170; p < 0.001) might have a significant impact on the prognosis.

Conclusion: Calcium, MWR, and PLR might be related to the prognosis of MPM patients. Analyzing the relationship between the results of inflammation-related and electrolyte laboratory variables in peripheral blood and prognosis could help clinicians evaluate the situation of patients.

Copyright © 2023 Zhang, Li and Zhang.

In plain English

This retrospective study looked at 90 non-surgical patients with malignant pleural mesothelioma diagnosed at Beijing Chaoyang Hospital, China, in 2010 to 2021. The authors examined whether blood tests at diagnosis were linked to survival. Of the 90 patients, 63 died during follow-up; median overall survival was 24 months. Twenty-four patients (26.7%) had been exposed to asbestos, which was not significantly linked to survival (hazard ratio 1.291, 95% confidence interval [CI] 0.748 to 2.226). In the adjusted analysis, comparing patients above with those at or below each cutoff, calcium above 2.1 mmol/L was linked to lower risk of death (hazard ratio 0.480, CI 0.270 to 0.855). Higher risk was linked to a platelet-to-lymphocyte ratio above 199.2 (hazard ratio 2.152, CI 1.163 to 3.981), a monocyte-to-white blood cell ratio above 0.079 (hazard ratio 3.360, CI 1.830 to 6.170) and age over 56.5 years (hazard ratio 2.548, CI 1.145 to 5.666). The authors concluded that calcium and both ratios were correlated with prognosis, calling for larger prospective studies. They noted the study was small, single-center and limited to non-surgical patients.

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 single-center study of prognostic factors, using Cox regression
• Who was studied: 90 patients with pathologically confirmed malignant pleural mesothelioma who had not undergone surgery, diagnosed at Beijing Chaoyang Hospital, China, from June 1, 2010 to July 1, 2021. Of 101 patients collected, 11 were excluded for incomplete data. 48 (53.3%) were male; median age was 65.0 years.
• Exposure: This was not an asbestos exposure study. The factors studied were pre-treatment blood tests (blood cell counts, ESR, sodium, potassium, calcium, and blood cell ratios such as PLR and MWR) plus clinical and imaging features. Asbestos exposure history was recorded: 24 of 90 patients (26.7%) had been exposed.
• Main results:
  • Of the 90 patients, 63 (70.0%) died during follow-up. Median overall survival was 24 months (IQR 12 to 52).
  • Survival rates for all patients were 87% at 6 months, 66% at 1 year, 39% at 2 years and 24% at 3 years.
  • In univariate analysis, asbestos exposure (24 patients) compared with no exposure (66 patients) was not significantly associated with survival: HR 1.291, 95% CI 0.748 to 2.226, p = 0.359.
  • In multivariable analysis, calcium above 2.1 mmol/L, compared with 2.1 or below, was associated with a lower hazard of death: HR 0.480, 95% CI 0.270 to 0.855, p = 0.013.
  • In multivariable analysis, a platelet-to-lymphocyte ratio above 199.2, compared with 199.2 or below, was associated with a higher hazard of death: HR 2.152, 95% CI 1.163 to 3.981, p = 0.015.
  • In multivariable analysis, a monocyte-to-white blood cell ratio above 0.079, compared with 0.079 or below, was associated with a higher hazard of death: HR 3.360, 95% CI 1.830 to 6.170, p less than 0.001.
  • In multivariable analysis, age over 56.5 years, compared with 56.5 or younger, was associated with a higher hazard of death: HR 2.548, 95% CI 1.145 to 5.666, p = 0.022.
• The authors' conclusion: The authors concluded that calcium, MWR and PLR are correlated with prognosis in malignant pleural mesothelioma, and that larger prospective studies are needed to validate the results.
• Limitations the authors state:
  • Single-center study with few patients; some groups were unbalanced, and bias was unavoidable.
  • Only non-surgical patients who had chemotherapy were included, so the results may not apply to all mesothelioma patients.
  • Not all prognostic factors were included, and most patients could not be accurately staged.

Topics

Medical terms in this study, explained in our Lexicon: Inflammation, Pleural Mesothelioma, Overall Survival, Biomarker, Median Overall Survival, Performance Status, Hazard Ratio, confidence interval.

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• Prognostic and Clinicopathological Significance of BAP1 Protein Expression in Different Types of Cancer-A Meta-Analysis — Z. Wang, X.Y. Wang, et al. (2018)
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• Significance of persistent inflammation in respiratory disorders induced by nanoparticles — Y. Morimoto, H. Izumi, et al. (2014)

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