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Duneesha De Fonseka, David T Arnold, Anna J Morley, Mary Brett, Nidhi Bhatt, Anthony Edey, Richard Daly, Anna C Bibby, Nick A Maskell
Academic Respiratory Unit, University of Bristol, Level 2, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK.
BMC Pulm Med. 2022 Apr 30;22(1):173. doi: 10.1186/s12890-022-01968-2.
As promising novel treatments develop for malignant pleural mesothelioma (MPM), early prognostication has become increasingly important. Circulating and local inflammatory cells are known to play a significant role in other tumour types. We assessed the proportion of lymphocyte populations within blood, pleural fluid and tumour stroma to prognosticate patients with MPM at diagnosis.
Consecutive patients diagnosed with biopsy-proven MPM were prospectively recruited to an observational cohort study and followed up for a minimum of 7.5 years. Blood and pleural fluid results at presentation were extracted from the medical records. Biopsy specimens were independently reviewed by 2 pathologists who scored the degree of lymphocytic and neutrophilic infiltration.
Baseline results were available for 184 patients. The predominant pleural fluid cell type was calculable for 84 patients and 118 patients had biopsy specimens available for review. A low blood neutrophil/lymphocyte ratio (NLR < 4) inferred a better prognosis with a median survival of 420 days versus 301 days (p < 0.01). Survival was better for patients with a lymphocyte-predominant pleural effusion (430 vs 306 days, p < 0.01). Lymphocyte infiltration of tumour stroma was also associated with improved survival (n = 92, survival 430 days) compared with neutrophilic or acellular samples (n = 26, survival 342 days p < 0.01). In multivariable modelling lymphocyte predominance in blood, pleural fluid and tumour stroma were all associated with a better prognosis.
Lymphocyte predominance within tumour stroma, pleural fluid or blood infers a better prognosis in patients with MPM.
随着恶性胸膜间皮瘤（MPM）有前途的新型治疗方法的发展，早期预后变得越来越重要。众所周知，循环和局部炎症细胞在其他肿瘤类型中起重要作用。我们评估了血液、胸腔积液和肿瘤基质中淋巴细胞群的比例，以预测 MPM 患者的诊断。
连续诊断为经活检证实的 MPM 的患者前瞻性纳入观察队列研究，并随访至少 7.5 年。从病历中提取就诊时的血液和胸腔积液结果。活检标本由 2 位病理学家独立审查，他们对淋巴细胞和中性粒细胞浸润的程度进行评分。
184 名患者的基线结果可用。对于 84 名患者可以计算主要胸腔积液细胞类型，118 名患者有活检标本可供审查。低血液中性粒细胞/淋巴细胞比值（NLR<4）提示预后较好，中位生存时间为 420 天，而 301 天（p<0.01）。淋巴细胞为主的胸腔积液患者的生存时间更好（430 天 vs 306 天，p<0.01）。肿瘤基质中淋巴细胞浸润也与生存改善相关（n=92，生存 430 天），与中性粒细胞或无细胞样本（n=26，生存 342 天，p<0.01）相比。在多变量模型中，血液、胸腔积液和肿瘤基质中的淋巴细胞优势均与更好的预后相关。
肿瘤基质、胸腔积液或血液中的淋巴细胞优势提示 MPM 患者预后较好。
