The Effect of Systemic Inflammation and Clinicopathologic Features on Survival in Malignant Pleural Mesothelioma: A Multicenter Analysis

Our plain-English summary of The Effect of Systemic Inflammation and Clinicopathologic Features on Survival in Malignant Pleural Mesothelioma: A Multicenter Analysis, by N. Sever, S. Yıldırım, A.F. Gurbuz, et al (Medicina, 2025).

The study

• Authors: N. Sever, S. Yıldırım, A.F. Gurbuz, D. Karakaş Kılıç, E. Zeynelgil, Y.E. Altintaş, B.D. Çimik, Y. Ağyol, A.K. Güren, P. Erel, E. Kocaaslan, B. Paçacı, M.A. Tunç, A. Çelebi, N.C. Demircan, S. Işık, R. Arıkan, M. Araz, S. Karakaya, M. Sarı, O. Köstek, İ.V. Bayoğlu
• Journal: Medicina
• Published: 2025;61(1)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background and Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis. Identifying reliable prognostic factors is crucial for risk stratification and optimizing treatment strategies. This study aimed to evaluate the impact of clinicopathologic factors and systemic inflammatory markers on survival outcomes in patients with MPM. Materials and Methods: This retrospective, multicenter study included 217 patients diagnosed with MPM between January 2009 and March 2024. Data on age, gender, histology, disease stage, treatment modalities, and inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR) were collected. Survival outcomes were analyzed using Kaplan-Meier methods, and prognostic factors were evaluated using Cox regression analysis. Results: CAR was identified as an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). Patients with CAR < 0.98 had significantly longer OS (87.0 months vs. 14.0 months, p < 0.001) and PFS (17.61 months vs. 8.96 months, p = 0.010). While NLR was significant in univariate analysis (OS: 25.0 months for NLR < 2.58 vs. 21.0 months for NLR ≥ 2.58, p = 0.040), it did not retain significance in the multivariate model (p = 0.180). Epithelioid histology and early-stage disease were strongly associated with improved survival outcomes (OS: 32.0 vs. 11.0 months for epithelioid vs. non-epithelioid histology, p < 0.001; 32.0 vs. 12.0 months for early-stage vs. metastatic disease, p < 0.001). Conclusions: CAR is a strong independent prognostic factor in MPM, reflecting systemic inflammation and nutritional status. Epithelioid histology and early-stage disease are associated with significantly longer survival, underscoring the critical role of early detection in improving patient outcomes.

In plain English

This retrospective study used records from several hospitals on 217 patients diagnosed with malignant pleural mesothelioma between January 2009 and March 2024. The authors asked whether blood markers of inflammation at diagnosis, and features such as tumor type and stage, were linked to survival. The main marker was the CRP/albumin ratio (CAR): C-reactive protein, a blood protein that rises with inflammation, divided by albumin. Asbestos exposure was reported by 58.1% of patients. Survival did not differ significantly between patients with and without reported exposure. Patients with CAR below 0.98 had a median overall survival of 87.0 months (95% confidence interval 40.32 to 133.68), compared with 14.0 months (11.02 to 16.79) for those at 0.98 or higher. CAR remained significant after adjusting for other factors. Patients with the epithelioid tumor type lived longer (median 32.0 versus 11.0 months), as did those without metastases at diagnosis (32.0 versus 12.0 months). A second marker, NLR, lost significance after adjustment. The authors concluded that CAR is an independent prognostic factor. They noted the retrospective design as a limitation. Some table figures conflict with the text.

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: Multicenter retrospective analysis of patient records (survival analysis using Kaplan-Meier and Cox regression)
• Who was studied: 217 patients diagnosed with malignant pleural mesothelioma between January 2009 and March 2024, followed and treated in oncology outpatient clinics at multiple institutions. Author affiliations are hospitals in Turkey. Median age was 59 years and 64.5% were male.
• Exposure: The study's focus was not asbestos. It examined blood inflammation markers at diagnosis: the CRP/albumin ratio (CAR, cut-off 0.98) and the neutrophil/lymphocyte ratio (NLR, cut-off 2.58), plus clinical features. Asbestos exposure was recorded only as reported yes or no (58.1% yes). No fiber types or doses were given.
• Main results:
  • Median overall survival for the whole cohort was 18.0 months. Median progression-free survival was 12.8 months.
  • Patients with CAR below 0.98 had a median overall survival of 87.0 months, versus 14.0 months for patients with CAR of 0.98 or higher (p less than 0.001).
  • In Table 3, the 95% confidence interval for median overall survival was 40.32 to 133.68 months for patients with CAR below 0.98. It was 11.02 to 16.79 months for patients with CAR of 0.98 or higher.
  • In multivariate analysis, CAR was an independent prognostic factor for overall survival (HR = 0.17, 95% CI 0.10 to 0.28, p less than 0.001).
  • In univariate analysis, patients with CAR below 0.98 had longer progression-free survival than those with CAR of 0.98 or higher (17.61 vs. 8.96 months, p = 0.010). Table 2 prints these two values the other way round.
  • NLR was significant in univariate analysis for overall survival (median 25.0 months for NLR below 2.58 vs. 21.0 months for NLR of 2.58 or higher, p = 0.040). It was not significant in the multivariate model (HR = 1.27, 95% CI 0.89 to 1.81, p = 0.180).
  • Epithelioid histology had longer median overall survival than non-epithelioid subtypes (32.0 vs. 11.0 months, p less than 0.001). In multivariate analysis, non-epithelioid histology had HR 2.44 (95% CI 1.72 to 3.45).
  • In Table 3, the 95% confidence interval for median overall survival was 23.51 to 40.48 months for epithelioid histology. It was 8.39 to 13.60 months for non-epithelioid histology.
  • Patients without metastases at diagnosis had longer median overall survival than those with metastases at diagnosis (32.0 vs. 12.0 months, p less than 0.001). In multivariate analysis, metastases had HR 1.86 (95% CI 1.33 to 2.60).
  • In Table 3, the 95% confidence interval for median overall survival was 24.02 to 39.97 months for patients without metastases at diagnosis. It was 9.36 to 14.63 months for patients with metastases at diagnosis.
  • Epithelioid histology was not significantly associated with progression-free survival (14.78 vs. 9.75 months, p = 0.437).
  • Surgery was associated with longer survival in univariate analysis (p less than 0.001) but not in multivariate analysis (p = 0.914).
  • Immunotherapy in any treatment line was associated with longer median overall survival (45.0 vs. 21.0 months, p = 0.016). It was not significant in multivariate analysis (p = 0.352).
  • Reported asbestos exposure was not significantly associated with overall survival (median 23.0 months exposed vs. 22.0 months not exposed, p = 0.820). It was also not associated with progression-free survival (p = 0.933).
• The authors' conclusion: The authors concluded that CAR is an independent prognostic factor, reflecting both inflammation and nutritional status. They also concluded that the longer survival seen with epithelioid histology and early-stage diagnosis shows the importance of early diagnosis and appropriate treatment planning.
• Limitations the authors state:
  • The retrospective design may lead to selection bias and limit generalizability.
  • Differences in diagnosis, treatment and follow-up between the participating centers may have influenced the results.
  • There were relatively few surgical patients, which may have limited the ability to detect survival differences between the two surgical techniques (EPP and PD).
  • The possible link between CAR and being a surgical candidate was not analyzed.
  • There is no standardized cut-off value for CAR and NLR, which may affect their usefulness and comparability across studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Inflammation, Pleural Mesothelioma, Prognosis, Histology, Overall Survival, Progression-Free Survival, Epithelioid, Non-epithelioid.

Related studies

• Chronic inflammation in tumor stroma is an independent predictor of prolonged survival in epithelioid malignant pleural mesothelioma patients — K. Suzuki, K. Kadota, et al. (2011)
• Health-related quality of life and inflammatory markers in malignant pleural mesothelioma — S.C. Kao, J. Vardy, et al. (2013)
• Histopathologic features predict survival in diffuse pleural malignant mesothelioma on pleural biopsies — C. Habougit, B. Trombert-Paviot, et al. (2017)
• Inflammation-based prognostic indices in malignant pleural mesothelioma — D.J. Pinato, F.A. Mauri, et al. (2012)
• Survival and prognostic factors in malignant pleural mesothelioma: a retrospective study of 314 patients in the west part of Japan — S. Nojiri, K. Gemba, et al. (2011)
• The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit of Multimodality Treatment in Pleural Mesothelioma — B. Mosleh, K. Sinn, et al. (2025)

Browse more research in Medicina, or return to medical research.