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Systemic Inflammation In Malignant Pleural Mesothelioma: Is Neutrophyl-to-lymphocyte Ratio A Prognostic Index?

F. Mucilli, P. Camplese, L. Guetti, B. Maggi, Marco Prioletta, M. Barone, A. Rizzuto, R. Sacco
Published 2016 · Medicine

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Malignant Pleural Mesothelioma (MPM) is an aggressive, asbestos-related tumor that arises from the mesothelium. It is a neoplasm with an increasing incidence with a poor and a dismal prognosis. Inflammation plays a crucial role in the initiation and tumor progression. In addition, the history of MPM is characterized by symptoms referred to increased inflammatory responses such as fever, sweating and loss of weight. Recent studies have identified the neutrophil-to-lymphocyte ratio (NLR) as a feaseble and simple marker of systemic inflammation. The Authors report a retrospective study in 54 patients with malignant pleural mesothelioma (MPM). MPM patients were more likely to be male (75.9% versus 24.1%) with a median age of 67 years. The epithelial histotype was predominant (77.8%) compared to the biphasic (11.1%), sarcomatous (9.5%) and desmoplastic (1.9%) ones. Neutrophil-to-Lymphocite ratio (NLR) was assessed at diagnosis with a mean value of 4.31. The aim of the study was to test bivariate correlations between independent factors (age, sex, histology, NLR, lymphocyte count, lymph node involvement) and the overall survival of the population under investigation. The median overall survival (OS) in the general population included in the study was 13 months. Median Disease Free Interval (DFI) was 3 months. Patients with the epithelial histotype survived significantly longer than those presenting with sarcomatoid, biphasic or desmoplastic subtypes (15 months versus 2, 8 and 10 months respectively; p<0.001). Patients with NLR<3 showed a median overall survival of 22 months, while 35 ones had a poorer survival rate (12 and 8 months respectively). There was evidenced of a strong correlation between patients with inflammation index less than three and overall survival (p<0.001). The Neutrophil-to-Lymphocyte Ratio (NLR) can be an independent, easily reproducibile and comparable prognostic index in patients with malignant pleural mesothelioma. Abbreviations: MPM: Malignant Pleural Mesothelioma, NLR: Neutrophil to Lymphocyte Ratio, OS: Overall Survival, DFI: Disease Free Interval
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