Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma

Abstract

Background: Recent studies proposed neutrophil-to-lymphocyte ratio (NLR) as a prognostic biomarker in malignant pleural mesothelioma (MPM). We examined baseline prognostic variables including NLR and the EORTC and CALGB models as predictors of overall survival (OS) in MPM.

Methods: In this retrospective study, 274 consecutive eligible, newly presenting patients with MPM were included. Of these, 159 received chemotherapy, 10 had tri-modality therapy, 2 underwent surgery only and 103 received supportive care alone. Univariate analyses and multivariate Cox models were calculated for OS.

Results: In univariate analysis, poor prognostic factors were: age ≥65 years, nonepithelioid histology, stage III-IV, poor performance status (PS), weight loss, chest pain, low haemoglobin and high platelet count. A baseline NLR≥ 5 did not predict worse OS (hazard ratio (HR) 1.25; P=0.122). On multivariate analysis, age, histology, PS, weight loss, chest pain and platelet count remained significant. The EORTC and CALGB prognostic groups were validated as predictive for OS (HR 1.62; P<0.001 and HR 1.65; P<0.001, respectively).

Conclusion: Our findings validate standard prognostic variables and the existing EORTC and CALGB models, but not NLR, at initial diagnosis of MPM. In guiding patient management at diagnosis, it is important to consider multiple baseline variables that jointly predict survival.

Figure 1

Study CONSORT diagram.

Figure 2

Univariate analyses of overall survival according to (A) EORTC prognostic group; (B) CALGB prognostic group; and (C) NLR. All at the time of diagnosis.

Figure 3

Univariate analyses of overall survival according to normalisation of NLR after one cycle of chemotherapy.

Figure 4

Neutrophil-to-lymphocyte ratio (mean and s.e.) at the time of diagnosis, prechemotherapy and after one cycle of treatment (n=157).