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Published on: October 2, 2015
The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit
Berta Mosleh1, Katharina Sinn1, Anna Cho2
1Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria.
Background/Objectives:
Malignant pleural mesothelioma (MPM) remains challenging to treat, with a poor prognosis. As controversy about clinical management continues, predictive biomarkers for patient selection to indicate the benefit of treatment modalities are urgently needed.
Methods:
In a retrospective analysis of 195 patients between 1994 and 2020 at the Department of Thoracic Surgery, Medical University of Vienna, Austria, the Mesothelioma Systemic Inflammation Score (MSIS)-consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen-was tested for its prognostic and predictive significance. The prognostic impact of MSIS was subsequently validated in an independent cohort of 80 patients treated at the Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, Vienna, Austria.
Results:
Median overall survival (OS) was 14 months for the entire cohort (95% CI: 11.4-16.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6-26.0; p < 0.001). In multivariable analysis, MSIS (p < 0.001), disease stage (p = 0.001), and the type of treatment (p = 0.004) were confirmed as independent predictors for OS. Higher MSIS was associated with shorter OS (p < 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (≤ 2) MSIS, multimodality therapy was associated with significantly prolonged OS when compared with chemo- and/or radiotherapy alone (25.8 months [95% CI: 16.4-35.3] vs. 14.4 months [95% CI: 10.4-18.4], p < 0.001). In contrast, among patients with elevated MSIS, no survival benefit was achieved by surgery over conservative treatment (11.8 months [95% CI: 8.3-15.3] vs. 8.2 months [95% CI: 5.2-11.3], p = 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort (p < 0.001).
Conclusions:
The Mesothelioma Systemic Inflammation Score was found to be an independent prognostic score in pleural mesothelioma, predicting benefit from macroscopic complete resection as part of multimodality treatment in distinct patients.
Insights
The Mesothelioma Systemic Inflammation Score (MSIS) predicts survival in malignant pleural mesothelioma. Low MSIS indicates benefit from surgery and multimodality treatment, improving overall survival.
Area of Science:
- Oncology
- Thoracic Surgery
- Biomarker Discovery
Background:
- Malignant pleural mesothelioma (MPM) presents a significant treatment challenge with a poor prognosis.
- Predictive biomarkers are crucial for selecting patients who will benefit from specific treatment modalities.
Purpose of the Study:
- To evaluate the prognostic and predictive significance of the Mesothelioma Systemic Inflammation Score (MSIS) in MPM patients.
- To determine if MSIS can identify patients who benefit from multimodality treatment including surgery.
Main Methods:
- Retrospective analysis of 195 MPM patients (1994-2020) to assess MSIS (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, CRP, fibrinogen).
- Validation of MSIS in an independent cohort of 80 patients.
- Multivariable analysis to identify independent predictors of overall survival (OS).
Main Results:
- Median OS was 14 months. Multimodality treatment with complete resection improved OS to 22.3 months (p < 0.001).
- MSIS, disease stage, and treatment type were independent OS predictors (p < 0.001). Higher MSIS correlated with shorter OS.
- Survival benefit from surgery was observed only in patients with low MSIS (25.8 months vs. 14.4 months for conservative treatment; p < 0.001).
Conclusions:
- MSIS is an independent prognostic score for pleural mesothelioma.
- MSIS predicts benefit from macroscopic complete resection within multimodality treatment for selected patients.
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