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. 2025 Feb 14;25(1):270.
doi: 10.1186/s12885-025-13606-1.

Prognostic importance of the neutrophil-to-lymphocyte ratio in malignant peritoneal mesothelioma patients receiving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Zhang Xinjing #  1 , Gong Lei #  2 , Li Xinbao  1 , Ji Zhonghe  1 , Yang Zhiran  1 , Gao Chao  1 , Zhang Kai  1 , Yan Lijun  1 , Yan Guojun  1 , Yu Junhui  1 , Zhang Yanbin  1 , An Songlin  3
Affiliations

Prognostic importance of the neutrophil-to-lymphocyte ratio in malignant peritoneal mesothelioma patients receiving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Zhang Xinjing et al. BMC Cancer. .

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare but aggressive cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was the preferred choice for selected patients. The purpose of this study was to thoroughly examine the impact of the combined treatment and the prognostic variables, particularly the neutrophil-to-lymphocyte ratio (NLR).

Methods: Characteristics of MPM patients who underwent CRS combined HIPEC treatment, followed by adjuvant chemotherapy were retrospectively collected. The univariable analysis was performed to identify the decisive influential factor. Using Kaplan-Meier analysis, the cumulative probability of survival was determined. Using Univariate Cox analysis, the prognostic factors-particularly NLR-and its correlation with survival were assessed. In the multivariate Cox proportional hazards model, predictive factors that demonstrated significance in univariate analysis were used. The degree of connection between predictors and survival was evaluated through the use of hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results: A total of 64 patients were enrolled in this study. The 1, 3, 5 years survival rates were 70.3%, 65.6%, 59.4%, respectively. According to multivariate Cox analysis, patients' survival was found to be substantially associated with post-operative NLR (HR 0.180, 0.067-0.531), Ki-67 (HR 0.184, 0.024-0.817), post-operative neutrophil count (HR 0.228, 0.075-0.696), and bidirectional pathological type (HR, 0.375, 0.146-0.964).

Conclusions: NLR is associated with the patients' prognosis after CRS combined HIPEC treatment.

Keywords: Cytoreductive Surgery; Hyperthermic Intraperitoneal Chemotherapy; Malignant Peritoneal Mesothelioma; Neutrophil-to-Lymphocyte Ratio; Prognosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study adhered to the Declaration of Helsinki and was approved by the ethic committee of Beijing Shijitan Hospital, Capital Medical University. Written informed consent was obtained from all the participants for the publication of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A, The 1-year, 3-year, 5-year overall survival rates were 70.3%, 65.6%, 59.4%, respectively. Factors reflecting the survival difference, with B as post-operative NLR, C as post-operative neutrophil count, D as post-operative lymphocyte count
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