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Updated: May 8, 2026
Orthotopic Implantation and Peripheral Immune Cell Monitoring in the II-45 Syngeneic Rat Mesothelioma Model
Published on: October 2, 2015
Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma
T M Meniawy1, J Creaney, R A Lake
11] M503, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia [2] National Centre for Asbestos Related Disease, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia [3] Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia.
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.
Insights
The neutrophil-to-lymphocyte ratio (NLR) does not predict survival in malignant pleural mesothelioma (MPM). Standard prognostic factors and existing models (EORTC, CALGB) are validated for predicting overall survival (OS) in MPM patients.
Area of Science:
- Oncology
- Pulmonology
- Biomarker Research
Background:
- Malignant pleural mesothelioma (MPM) survival prediction is crucial for patient management.
- Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic biomarker in MPM.
- Existing prognostic models like EORTC and CALGB require validation with new biomarkers.
Purpose of the Study:
- To evaluate the prognostic value of baseline neutrophil-to-lymphocyte ratio (NLR) in patients with malignant pleural mesothelioma (MPM).
- To validate established prognostic models (EORTC, CALGB) and baseline variables for predicting overall survival (OS) in MPM.
- To identify key predictors of OS at initial diagnosis for guiding patient management.
Main Methods:
- Retrospective analysis of 274 eligible MPM patients.
- Inclusion of baseline prognostic variables, including NLR, performance status (PS), histology, and disease stage.
- Application of univariate and multivariate Cox regression models to assess predictors of overall survival (OS).
Main Results:
- Poor prognostic factors identified: advanced age, non-epithelioid histology, stage III-IV, poor PS, weight loss, chest pain, low hemoglobin, and high platelet count.
- Baseline NLR (≥5) did not significantly predict worse OS (HR 1.25; P=0.122).
- Multivariate analysis confirmed age, histology, PS, weight loss, chest pain, and platelet count as significant predictors of OS. EORTC and CALGB models were validated (HR 1.62; P<0.001 and HR 1.65; P<0.001).
Conclusions:
- Standard prognostic variables and the EORTC/CALGB models are validated predictors of OS in MPM at initial diagnosis.
- Neutrophil-to-lymphocyte ratio (NLR) is not a validated prognostic biomarker for MPM in this cohort.
- Comprehensive assessment of multiple baseline variables is essential for accurate survival prediction and patient management in MPM.
