Potential Novel Prognostic Factors in Malign Mesothelioma: Systemic Inflammatory Indices (SII) & Albumin-to-Globulin Ratio (AGR)

INTRODUCTION: Malignant mesothelioma (MM) is rare with poor prognosis and often diagnosed at advanced stage. Systemic inflammatory indices (SII) may have prognostic value in cancer. Albumin is a negative acute phase reactant. We evaluated the prognostic significance of SII and albumin to globulin ratio (AGR) in MM followed-up at a single institute
METHODS: Fifty-six MM patients who met the inclusion criteria at our oncology cenrter were included in the study. Patients aged over 18 years with pathologically confirmed malignant pleural and peritoneal mesothelioma and no secondary malignancy followed up at our center were included in the study. Laboratory parameters for estimation of SII and AGR at diagnosis were obtained from database. Those with active infection, which might affect these parameters, those with a medical history of steroid use were excluded from the study.
RESULTS: Median follow-up was 13.5 months. Most of the patients were female (58.9%). Median overall survival (OS) was 13 months. Median OS was 16 months in the pleural mesothelioma group and 9 months in the peritoneal mesothelioma group (p=0.982).OS was negatively correlated with platelet count, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) (p1=0.015, p2=0.009 p3=0.004;respectively).On the other hand, OS was positively correlated with lymphocyte count, albumin and AGR (p1=0.032, p2<0.001, p3=0.004; respectively). Median OS was 22 months in patients with higher albumin level ( >3.5 g/dL) while it was 9 months in others with lower albumin level ( ≤3.5 g/dL), respectively (p=0.03). In multivariate Cox regression analysis, platelet count, lymphocyte count, NLR, PLR, albumin and AGR were determined as independent prognostic factors for OS (p1<0.001, p2=0.001, p3=0.026, p4<0.001, p5=0.03, p6=0.008;respectively)
DISCUSSION AND CONCLUSION: It has been demonstrated that albumin, AGR, NLR, PLR, platelet and lymphocyte counts are independent prognostic factors for OS in MM.

Malign Mezotelyomada Potansiyel Yeni Prognostik Faktörler: Sistemik Ýnflamatuar Ýndeksler (SII) ve Albümin-Globulin Oraný (AGO)

GÝRÝÞ ve AMAÇ: Malign mezotelyoma (MM) sýklýkla ileri evrede taný alan kötü prognozlu nadir bir hastalýktýr. Sistemik inflamatuar indeksler (SII) kanserde prognostik deðerlere sahip olabilir. Albümin, negatif bir akut faz reaktanýdýr. Sunulan çalýþmada MM takibinde SII ve albüminin globulin oranýnýn (AGO) prognostik önemini deðerlendirdik
YÖNTEM ve GEREÇLER: Merkezimizde dahil edilme kriterlerini karþýlayan 56 MM hastasý çalýþmaya dahil edildi. 18 yaþ üstü, patolojik olarak doðrulanmýþ malign plevral ve peritoneal mezotelyoma olan sekonder malignitesi olmayan hastalar çalýþmaya dahil edildi. Taný anýnda SII ve AGR laboratuvar parametreleri veri tabanýndan retrospektif oalrak kaydedildi.Bu parametreleri etkileyebilecek aktif enfeksiyonu olanlar, steroid kullaným öyküsü olanlar çalýþma dýþý býrakýldý.
BULGULAR: Medyan takip süresi 13,5 aydý. Hastalarýn çoðunluðu (%58.9) kadýndý. Medyan genel saðkalým (OS) 13 aydý. Median OS, plevral mezotelyoma grubunda 16 ay ve peritoneal mezotelyoma grubunda 9 aydý (p=0.982). OS, trombosit sayýsý, nötrofil/lenfosit oraný (NLR) ve trombosit/lenfosit oraný (PLR) ile negatif korelasyon gösterdi (p1= 0,015, p2=0,009 p3=0,004;sýrasýyla).Öte yandan OS, lenfosit sayýsý, albümin ve AGR ile pozitif korelasyon gösterdi (sýrasýyla p1=0,032, p2<0,001, p3=0,004;). Ortalama OS, albümin düzeyi yüksek (>3,5 g/dL) hastalarda 22 ay iken, albümin düzeyi düþük olanlarda ( ≤3,5 g/dL) sýrasýyla 9 aydý (p=0,03). Çok deðiþkenli Cox regresyon analizinde trombosit sayýsý, lenfosit sayýsý, NLR, PLR, albümin ve AGR, OS için baðýmsýz prognostik faktörler olarak belirlendi (p1<0,001, p2=0,001, p3=0,026, p4<0,001, p5=0,03, p6= 0.008; sýrasýyla)
TARTIÞMA ve SONUÇ: Çalýþmada albümin, AGO, NLR, PLR, trombosit ve lenfosit sayýlarýnýn MM'de OS için baðýmsýz prognostik faktörler olduðu gösterilmiþtir.