| BackgroundMalignant pleural mesothelioma is a kind of thoracic cancer that is associated with exposure to asbestos and highly aggressive. Though the production of asbestos has been strictly limited, the morbidity of malignant pleural mesothelioma has not declined. With the improvement of treatment for patients with malignant pleural mesothelioma, the median overall survival haven’t increased dramatically. Until now the existing prognostic scoring system for patients with malignant pleural mesothelioma includes the European Organization for Research and Treatment of Cancer (EORTC) and the Cancer and Leukemia Group B (CALGB), which take gender, histological subtype and other factors into account. Because of their complexity, the prognostic scoring systems are rarely applied in clinical practice. And it brings new demand for the explore of prognostic factors for patients with malignant pleural mesothelioma. The association between immune system and cancer is a new aspect of interest nowadays, not only in the function of immune system to destroy cancer cells, but also in its function to create an favorable microenvironment for tumor evasion and metastasis. Lymphocyte-to-monocyte ratio (LMR) has been identified as an independent prognostic factors in multiple malignant diseases. We know little about the relationship between LMR and malignant pleural mesothelioma.ObjectiveTo explore the relationship between pretreatment absolute lymphocyte count, absolute monocyte count, lymphocyte-to-monocyte ratio in peripheral blood and prognosis of patients with malignant pleural mesothelioma.Materials and methods1. Objective of the researchA total number of 85 patients who were admitted to Department of Respiratory of the Provincial Hospital Affiliated to Shandong University in January 2010 to July 2015 with MPM, with 56 males and 29 females, and the average age were 58.31 years old.1.1 Inclusion criteria and exclusion criteriaThe followings are the criteria for inclusion:1) The clinical information is complete. 2) They are newly diagnosed with malignant pleural mesothelioma with pathological confirmation after thoracoscopy.3) They had never received any radiotherapy, chemotherapy or surgical therapy. The followings are the criteria for exclusion:1) They have significant evidence for infection.2) They are previously diagnosed with malignant disease, such as breast cancer or Hodgkin’s lymphoma.3) They are diagnosed with connective tissue disease.4) Patients were lost to follow-up.2. Grouping methodAccording to the average value of pretreatment ALC, AMC, LMR, patients are divided into high ALC group and low ALC group, high AMC group and low AMC group, high LMR group and low LMR group, respectively.3. Data collectionThrough medical records, we got access to the information we need, which includes patients’gender, age, history of smoking, clinical symptoms such as chest distress, chest pain and loss of weight, CT scan, treatment method and pretreatment absolute lymphocyte count, absolute monocyte count and albumin in peripheral blood. Patients’ pathological type and histological subtype were identified after one pathological doctor in our hospital checked all the pathological section, tumor stage and performance status scores were ensured by one physician according to medical records.4. Follow-upThe deadline date for follow-up was January 2016, and the main method for follow-up was outpatient and telephone call. The most important information we need to follow is the living status of patients, and if patients were dead, we need to know clearly the exact date of death.5. Statistical methodsData were processed by SPSS 19.0 statistical software package. The measurement data were expressed as (x±s), and the differences between groups were measured by two independent samples t-test. And the count data were defined as a percentage and compared by means of the chi-square test. The overall survival were compared by Kaplan-Meier survival curve, and compared by log rank test. Univariate and multivariate analysis by Cox’s proportional hazards regression model were performed to get the factors associated with prognosis of patients with malignant pleural mesothelioma. P<0.05 was defined to be statistically differences.Results1. GroupingThe average value of absolute lymphocyte count, absolute monocyte count and lymphocyte-monocyte ratio were 1.46*109/L,0.71*109/L,2.51, respectively. According to these values, patients were divided into high ALC group (ALC≥1.46*109/L, n=44) and low ALC group (ALC<1.46* 109/L, n=41), high AMC group (AMC≥0.71*109/L, n=31) and low AMC group (AMC<0.71*109/L, n=54), high LMR group (LMR≥2.51, n=35) and low LMR group (LMR<2.51, n=50).2. Comparisions of clinical-pathological features between groupsNo significant differences were observed between high ALC group and low ALC group in clinical-pathological features, such as gender, age, histology of smoking, treatment modality, clinical features, tumor stage, histological subtype, performance status score, and albumin (P> 0.05).No significant differences were observed between high AMC group and low AMC group in these clinical-pathological features, such as age, histology of smoking, clinical features, tumor stage, histological subtype, performance status score (P>0.05). However, the proportion of males were significantly higher in high AMC group than that of low AMC group (83.9% vs 55.6%, P=0.008). The proportion of patients with non-systemic chemotherapy was significantly higher in high AMC group than that of low AMC group (80.6% vs 59.3%, P=0.043), and high level of albumin was less common in high AMC group than that in low AMC group (22.6% vs 59.3%, P= 0.001).No significant differences were observed between high LMR group and low LMR group in these clinical-pathological features, such as age, histology of smoking, clinical features, treatment modality, tumor stage, histological subtype (P > 0.05). Compared with the low LMR group, in the high LMR group the proportion of female was higher (51.4% vs 22.0%, P=0.005), more patients were with a performance status score of no more than 1 (82.9% vs 60.0%, P=0.024), and more patients with high level of albumin (65.7% vs 32.0%, P=0.002).3. Comparisions of overall survival time between groupsNo significant difference were observed in overall survival time between high ALC group and low ALC group (P> 0.05).The median overall survival time in high AMC group were eight months (95% CI, 5.3-10.7 months), which was significantly shorter than that in low AMC group (17 months,95% CI:11.8-22.2 months, P= 0.004).The median overall survival time in high LMR group were 22 months (95% CI, 19.3-24.7 months), which was significantly longer than that in low LMR group (9 months,95% CI:5.5-12.5 months, P< 0.001).4. Univariate and multivariate analysisBy univariate analysis, we found that gender (HR,1.836; 95% CI,1.107-3.044; P=0.019), absolute monocyte count (HR,1.972; 95% CI,1.217-3.195; P=0.006) and the LMR value (HR,2.415; 95% CI,1.472-3.964; P＜0.001), the level of albumin (HR,2.413; 95% CI,1.477-3.941; P＜0.001), tumor stage (HR,1.998; 95% CI, 1.245-3.206; P=0.004), histological subtype (HR,1.625; 95% CI,1.016-2.599; P=0.043) were significantly associated with the overall survival in patients with malignant pleural mesothelioma. By multivariate analysis, we found that gender (HR, 2.260; 95% CI,1.034-4.937; P=0.041), the LMR value (HR,2.689; 95% CI,1.166- 6.201; P= 0.020), tumor stage (HR,2.016; 95% CI,1.066-3.813; P= 0.031), performance status scores (HR,2.226; 95% CI,1.016-4.479; P= 0.025) and histological subtype (HR,2.125; 95% CI,1.135-3.979; P= 0.018) were independent factors that associated with the overall survival in patients with malignant pleural mesothelioma.Conclusions1. Pretreatment absolute lymphocyte count, absolute monocyte count in peripheral blood are not independent prognostic factors for patients with malignant pleural mesothelioma.2. Pretreatment lymphocyte to monocyte ratio in peripheral blood is an independent factor associated with the prognosis of patients with malignant pleural mesothelioma. |
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