Mosleh Berta, Sinn Katharina, Cho Anna, Reiner Anton, Steindl Ariane, Lang Christian, Zöchbauer-Müller Sabine, Dieckmann Karin, Widder Joachim, Prosch Helmut, Dome Balazs, Schelch Karin, Aigner Clemens, Klikovits Thomas, Benej Michal, Watzka Stefan, Filipits Martin, Bölükbas Servet, Sarova Pavla, Gompelmann Daniela, Grusch Michael, Hoda Mir Alireza
Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria.
Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria.
Cancers (Basel). 2025 Apr 20;17(8):1371. doi: 10.3390/cancers17081371.
BACKGROUND/OBJECTIVES: Malignant pleural mesothelioma (MPM) remains challenging to treat, with a poor prognosis. As controversy about clinical management continues, predictive biomarkers for patient selection to indicate the benefit of treatment modalities are urgently needed.
In a retrospective analysis of 195 patients between 1994 and 2020 at the Department of Thoracic Surgery, Medical University of Vienna, Austria, the Mesothelioma Systemic Inflammation Score (MSIS)-consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen-was tested for its prognostic and predictive significance. The prognostic impact of MSIS was subsequently validated in an independent cohort of 80 patients treated at the Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, Vienna, Austria.
Median overall survival (OS) was 14 months for the entire cohort (95% CI: 11.4-16.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6-26.0; < 0.001). In multivariable analysis, MSIS ( < 0.001), disease stage ( = 0.001), and the type of treatment ( = 0.004) were confirmed as independent predictors for OS. Higher MSIS was associated with shorter OS ( < 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (≤ 2) MSIS, multimodality therapy was associated with significantly prolonged OS when compared with chemo- and/or radiotherapy alone (25.8 months [95% CI: 16.4-35.3] vs. 14.4 months [95% CI: 10.4-18.4], < 0.001). In contrast, among patients with elevated MSIS, no survival benefit was achieved by surgery over conservative treatment (11.8 months [95% CI: 8.3-15.3] vs. 8.2 months [95% CI: 5.2-11.3], = 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort ( < 0.001).
The Mesothelioma Systemic Inflammation Score was found to be an independent prognostic score in pleural mesothelioma, predicting benefit from macroscopic complete resection as part of multimodality treatment in distinct patients.
背景/目的：恶性胸膜间皮瘤（MPM）的治疗仍然具有挑战性，预后较差。由于临床管理方面的争议仍在继续，迫切需要预测性生物标志物来选择患者，以表明治疗方式的益处。
在对奥地利维也纳医科大学胸外科1994年至2020年期间的195例患者进行的回顾性分析中，测试了间皮瘤全身炎症评分（MSIS）（由治疗前中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C反应蛋白（CRP）和纤维蛋白原组成）的预后和预测意义。随后，在奥地利维也纳弗洛里茨多夫诊所卡尔·兰德施泰纳临床与转化胸外科研究所胸外科治疗的80例独立患者队列中验证了MSIS的预后影响。
整个队列的中位总生存期（OS）为14个月（95%CI：11.4 - 16.6）。接受包括宏观完全切除在内的多模式治疗的患者OS更长（22.3个月，95%CI：18.6 - 26.0；<0.001）。在多变量分析中，MSIS（<0.001）、疾病分期（=0.001）和治疗类型（=0.004）被确认为OS的独立预测因素。较高的MSIS与较短的OS相关（<0.001）。包括手术在内的多模式治疗方案的显著生存获益仅限于MSIS较低的患者。在MSIS低（≤2）的患者中，与单纯化疗和/或放疗相比，多模式治疗与显著延长的OS相关（25.8个月[95%CI：16.4 - 35.3]对14.4个月[95%CI：10.4 - 18.4]，<0.001）。相比之下，在MSIS升高的患者中，手术相对于保守治疗未实现生存获益（11.8个月[95%CI：8.3 - 15.3]对8.2个月[95%CI：5.2 - 11.
