Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy.
BACKGROUND
Survival after extrapleural pneumonectomy (EPP) is variable in patients with malignant pleural mesothelioma (MPM), and there are no validated prognostic factors that could be used preoperatively. We investigated the calretinin and D2-40 expression and the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation as potential preoperative prognostic factors.


METHODS
Consecutive patients who underwent EPP were included in this retrospective study. Potential prognostic factors such as age, gender, histological subtype, baseline laboratory parameters including NLR, and immunohistochemical staining for calretinin and D2-40 were evaluated. Overall survival (OS) from the date of surgery was determined by the Kaplan-Meier method. The prognostic value of the variables was examined using Cox regression, and significant factors (p < 0.05) were entered into a multivariate model to determine their independent effect.


RESULTS
A total of 85 patients were included: median age 58 years; 80% men; 77% epithelial and 23% biphasic MPM. The median OS was 19.7 months. The following variables were predictive of longer OS: female gender (p = 0.02), epithelial subtype (p = 0.04), low NLR (p < 0.01), and high calretinin score (p < 0.001). In a multivariate analysis, only NLR ≥3 (hazard ratio 1.79; 95% confidence interval: 1.04-3.07; p = 0.04) and calretinin score ≤33 versus more than 67% (hazard ratio 4.72; 95% confidence interval: 1.97-11.32; p < 0.01) remained independent predictors. The addition of calretinin score increased the explained variation by 10.1%.


CONCLUSIONS
Both low calretinin expression and high NLR were independently associated with poor prognosis in patients with MPM undergoing EPP, and the calretinin score seemed to improve the accuracy of the prognostic model.
Asbestos Diseases Research Institute, Bernie Banton Centre, Sydney, Australia. Steven.Kao2@sswahs.nsw.gov.au
Steven Chuan-Hao
SC
Kao
Sonja
S
Klebe
Douglas W
DW
Henderson
Glen
G
Reid
Mark
M
Chatfield
Nicola J
NJ
Armstrong
Tristan D
TD
Yan
Janette
J
Vardy
Stephen
S
Clarke
Nico
N
van Zandwijk
Brian
B
McCaughan
D000328:Adult; D000368:Aged; D064032:Calbindin 2; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D064030:S100 Calcium Binding Protein G / Q000378:metabolism*; D015996:Survival Rate; D055815:Young Adult
C576764:CALB2 protein, human; D064032:Calbindin 2; D064030:S100 Calcium Binding Protein G