Lymphocyte predominance in blood, pleural fluid, and tumour stroma; a prognostic marker in pleural mesothelioma

Abstract

Background 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. Methods 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. Results 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. Conclusions Lymphocyte predominance within tumour stroma, pleural fluid or blood infers a better prognosis in patients with MPM.

Reflecting real-world patients with mesothelioma in research: an interim report of baseline characteristics from the ASSESS-meso cohort

“…As well as descriptive data on participants’ characteristics, summary statistics of our cohort were consistent with existing, established understanding of the disease. Specifically, the factors associated with shorter survival, namely non-epithelioid histology, poor performance status and inflammatory markers in the form of raised NLR, were consistent with prior evidence [ 2 , 44 , 45 ]. The ability of Brims score, a prognostic model derived from two international clinical cohorts, to predict survival within ASSESS-meso adds further validation to the scoring system, and further supports the external validity of ASSESS-meso.…”

Long term association between frailty and survival in patients with pleural disease: a cohort study protocol

“…Samples and data from this cohort of patients have been utilised in multiple studies previously, to improve the diagnostic and management pathway of patients with pleural disease. [14][15][16][17] This is a retrospective analysis of data from outpatients recruited to this single-centre database between March 2008 and December 2020.…”

“…Samples and data from this cohort of patients have been utilised in multiple studies previously, to improve the diagnostic and management pathway of patients with pleural disease. 14–17…”

New Markers for Management of Mesothelioma

“…Of note, a low blood neutrophil to lymphocyte ratio has been shown to predict better prognosis in different patient cohorts. 57 Tissue expression of the programmed death ligand 1 (PD-L1) has been shown in two studies to be an independent negative prognostic marker. 58,59 Predictive Biomarkers for Standard of Care Treatment Current treatment options for mesothelioma include surgery, radiotherapy, chemotherapy, immunotherapy, or combinations thereof.…”

“…Of note, a low blood neutrophil to lymphocyte ratio has been shown to predict better prognosis in different patient cohorts. 57 Tissue expression of the programmed death ligand 1 (PD-L1) has been shown in two studies to be an independent negative prognostic marker. 58 59…”