Prognostic value of SUVpeak and prognostic nutritional index in patients with pleural mesothelioma treated with platinum-based chemotherapy

Our plain-English summary of Prognostic value of SUVpeak and prognostic nutritional index in patients with pleural mesothelioma treated with platinum-based chemotherapy, by Y. Kato, K. Hashimoto, H. Imai, et al (Translational Lung Cancer Research, 2026).

The study

• Authors: Y. Kato, K. Hashimoto, H. Imai, K. Kaira, R. Ishii, N. Hashimoto, O. Yamaguchi, A. Mouri, H. Kagamu, I. Kuji
• Journal: Translational Lung Cancer Research
• Published: 2026;15(8):243
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma (PM) is an aggressive malignancy with poor prognosis, and reliable prognostic biomarkers are needed to better inform clinical management. We retrospectively investigated the prognostic value of the Glasgow prognostic score (GPS), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), and tumor glucose metabolism measured by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

Methods: We retrospectively reviewed patients with PM treated with first-line platinum-pemetrexed chemotherapy at our institution (April 2007-December 2023; data cutoff, December 2024) and evaluated the prognostic value of these markers and baseline FDG-PET parameters.

Results: Among 79 patients diagnosed with PM, 51 who received first-line platinum-based chemotherapy with pemetrexed were analyzed. The median age was 69 (range, 42-81) years, 78% were male, and 67% had epithelioid histology. The objective response rate (ORR) was 27.5% [95% confidence interval (CI), 17.1-40.9%], and the disease control rate (DCR) was 72.5% (95% CI, 59.1-82.9%). The median progression-free survival (PFS) and overall survival (OS) were 5.8 (95% CI, 3.4-7.8) and 21.8 (95% CI, 13.4-33.5) months, respectively. Low PNI (≤45) was significantly associated with shorter OS than high PNI (>45) (18.8 vs. 28.5 months; P=0.04) and remained an independent prognostic factor in multivariable analysis (P=0.04). For 35 patients who underwent pretreatment 18F-FDG-PET, high peak standardized uptake value (SUVpeak) (>7.73) was significantly associated with worse OS than low SUVpeak (9.1 vs. 33.6 months; P<0.001) and remained an independent predictor in the multivariable analysis (P<0.001). None of the evaluated biomarkers significantly predicted PFS. GPS, NLR, and BMI showed no significant association with survival outcomes in the univariate analysis and were therefore not included in the multivariable models.

Conclusions: Low PNI and high SUVpeak significantly predicted poor OS in patients with PM treated with platinum-based chemotherapy. These factors may serve as practical prognostic indicators in this population.

© AME Publishing Company.

In plain English

This retrospective study at one Japanese hospital reviewed 51 pleural mesothelioma patients, diagnosed 2007 to 2023, given first-line platinum plus pemetrexed chemotherapy. Median progression-free survival, counted from treatment start, was 5.8 months (95% CI 3.4 to 7.8). Median overall survival, counted from diagnosis, was 21.8 months (95% CI 13.4 to 33.5). Of 50 patients with a prognostic nutritional index (from blood albumin and lymphocyte count), the 33 scoring 45 or less had median overall survival of 18.8 months, against 28.5 months for the 17 above. The adjusted hazard ratio for low versus high scores was 2.04 (95% CI 1.03 to 4.04; P=0.04). Of 35 patients with pretreatment PET scans, the 8 with high tumor uptake (SUVpeak above 7.73) had median overall survival of 9.1 months versus 33.6 months. No blood or PET marker was significantly associated with progression-free survival; performance status was. Asbestos exposure history (yes or no) was associated with overall survival in unadjusted whole-cohort analysis; no adjusted result was reported. The authors concluded both markers were independent prognostic factors. They noted the small sample, same-data cutoffs, and no external validation.

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 cohort study (review of medical records)
• Who was studied: Of 79 patients with pleural mesothelioma diagnosed pathologically between April 2007 and December 2023 at Saitama Medical University International Medical Center, Japan, 51 received first-line platinum plus pemetrexed chemotherapy and were analyzed. Median age was 69 years, 40 were male, and 34 had epithelioid histology. Of the 51, 35 had a pretreatment FDG-PET/CT scan, and PNI could be calculated for 50. Data cutoff was December 2024.
• Exposure: The study examined prognostic markers, not asbestos exposure. These were the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio, Glasgow prognostic score, body mass index, and FDG-PET tumor uptake (SUVmax and SUVpeak). All patients received cisplatin or carboplatin with pemetrexed, with bevacizumab in some. Asbestos exposure history was recorded only as yes or no (32 yes, 19 no). No fiber types or doses were reported.
• Main results:
  • Whole cohort (51 patients): median progression-free survival was 5.8 months (95% CI 3.4 to 7.8) and median overall survival was 21.8 months (95% CI 13.4 to 33.5). By December 2024, 44 of 51 patients had died.
  • The two survival measures had different starting points. Progression-free survival was measured from the start of treatment. Overall survival was measured from the date of pathological diagnosis.
  • Whole cohort: the objective response rate to chemotherapy was 27.5% (95% CI 17.1 to 40.9%), made up of 1 complete and 13 partial responses.
  • PNI was calculable in 50 patients: 33 had PNI of 45 or less and 17 had PNI above 45. Median overall survival was 18.8 months in the low-PNI group and 28.5 months in the high-PNI group.
  • Whole cohort, multivariable analysis: low PNI (45 or less versus above 45) had a hazard ratio for worse overall survival of 2.04 (95% CI 1.03 to 4.04 per Table 3), P=0.04.
  • PET subgroup (35 patients): median overall survival was 9.1 months with SUVpeak above 7.73 and 33.6 months with SUVpeak of 7.73 or less (log-rank P less than 0.001). In the multivariable analysis, the hazard ratio for low versus high SUVpeak was 0.08 (95% CI 0.02 to 0.34), P less than 0.001. Only 8 patients were in the high-SUVpeak group.
  • No blood- or PET-derived biomarker was significantly associated with progression-free survival. ECOG performance status was the factor associated with early progression: median progression-free survival was 5.8 months for performance status 0 to 1 and 1.2 months for performance status 2.
  • Glasgow prognostic score, neutrophil-to-lymphocyte ratio and body mass index showed no significant association with progression-free or overall survival in the univariate analysis.
  • Whole cohort, univariate (unadjusted) analysis: a recorded history of asbestos exposure (yes versus no) was associated with overall survival, with a hazard ratio of 0.44 (95% CI 0.22 to 0.87), P=0.02. Median overall survival was 23.2 months with a history and 19.5 months without (Table 3). Table 3 gives no multivariable (adjusted) result for this variable, and the authors did not discuss the finding further.
• The authors' conclusion: The authors concluded that SUVpeak on FDG-PET/CT and the PNI are both independent prognostic factors for overall survival in patients with pleural mesothelioma receiving platinum-based chemotherapy. They added that the two may serve as complementary risk-stratification tools, pending validation in larger prospective studies.
• Limitations the authors state:
  • Retrospective design and single-center setting may limit generalizability.
  • The sample size was limited, particularly in the PET/CT subgroup of 35 patients.
  • Some patients received immune checkpoint inhibitors during follow-up, which may have influenced overall survival.
  • There was no external validation cohort to confirm the cutoff values and associations.
  • Cutoffs were derived from the same cohort and are exploratory. The size of the SUVpeak hazard ratio was unstable because the high-SUVpeak group was small.
  • Blood glucose levels at the time of PET/CT were not available.
  • Clinical staging used different editions of the TNM classification over the study period, and histological subtype was unknown in eight patients.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Prognosis, Biomarker, Platinum-Pemetrexed, Pemetrexed (Alimta), Epithelioid, Histology.

Related studies

• The Predictive Value of ERCC1, RRM1, and Thymidylate Synthase in Advanced Malignant Pleural Mesothelioma Patients Treated with Platinum-Based Chemotherapy — N.I. Wahba, O. Khorshid, et al. (2023)
• Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery — L. Frischknecht, M. Meerang, et al. (2015)
• MiR-193b-3p and miR-132-3p as prognostic biomarkers of survival in pleural mesothelioma patients treated with first-line bevacizumab plus pemetrexed-platinum chemotherapy in the IFCT-0701 MAPS phase 3 trial — G. Levallet, C. Creveuil, et al. (2025)
• Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma — Z.H. Yao, G.Y. Tian, et al. (2013)
• Phase 2 study of sorafenib in malignant mesothelioma previously treated with platinum-containing chemotherapy — S. Papa, S. Popat, et al. (2013)
• DNA repair polymorphisms and treatment outcomes of patients with malignant mesothelioma treated with gemcitabine-platinum combination chemotherapy — N. Erčulj, V. Kovač, et al. (2012)

Browse more research in Translational Lung Cancer Research, or return to medical research.