Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa Ube, Yamaguchi, 755-0241, Japan.
Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa Ube, Yamaguchi, 755-0241, Japan.
Surg Oncol. 2022 Aug;43:101813. doi: 10.1016/j.suronc.2022.101813. Epub 2022 Jul 6.
A preoperative validation system for predicting the clinical outcome of extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) is required, as EPP for MPM is one of the most invasive operation types. Recently, several inflammatory and nutritional parameters, such as C-reactive protein (CRP) and albumin, have been re-focused on as useful prognostic factors for several types of cancer; however, few of these reports involved MPM.
As a retrospective study, clinicopathological characteristics and preoperative inflammatory and nutritional parameters were calculated in consecutive patients with MPM who underwent EPP. The prognostic value of the variables was examined using Cox regression, and the candidate preoperative parameters were entered into a multivariate model to determine their independent effects.
Of the 61 eligible cases, the CRP/albumin ratio (CAR) was associated with histology, and the CRP index multiplied by the neutrophil ratio (C-NR index) was associated with histology and pathological stage. Patients with CAR >0.125 had a significantly poor survival outcome, and patients with a C-NR index >0.58 also had a significantly poor prognosis. Multivariate analysis showed that age, histology, CRP, albumin, CAR, and C-NR index were independent predictors of 5-year overall survival.
Our results demonstrated that the CAR and C-NR indices are promising preoperative predictive parameters for the clinical outcomes of EPP in patients with MPM.
对于恶性胸膜间皮瘤(MPM)的胸膜外全肺切除术(EPP),需要一个术前验证系统来预测临床结果,因为 EPP 是最具侵袭性的手术类型之一。最近,几种炎症和营养参数,如 C 反应蛋白(CRP)和白蛋白,已重新被聚焦为几种癌症的有用预后因素;然而,这些报告中很少涉及 MPM。
作为一项回顾性研究,对连续接受 EPP 治疗的 MPM 患者的临床病理特征和术前炎症及营养参数进行了计算。使用 Cox 回归检查了变量的预后价值,并将候选术前参数输入多变量模型,以确定它们的独立影响。
在 61 例合格病例中,CRP/白蛋白比值(CAR)与组织学有关,而 CRP 指数乘以中性粒细胞比(C-NR 指数)与组织学和病理分期有关。CAR>0.125 的患者生存结果明显较差,C-NR 指数>0.58 的患者预后也明显较差。多变量分析表明,年龄、组织学、CRP、白蛋白、CAR 和 C-NR 指数是 MPM 患者 EPP 5 年总生存率的独立预测因素。
我们的结果表明,CAR 和 C-NR 指数是预测 MPM 患者 EPP 临床结果的有前途的术前预测参数。