Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy

Steven Kao, Sonja Klebe, Douglas Henderson, Glen Reid, Mark Chatfield, Nicola Armstrong, Tristan Yan, Janette Vardy, Stephen Clarke, Nico van Zandwijk, Brian McCaughan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Survival after extrapleural pneumonectomy (EPP) is variable in patients with malignant pleural mesothelioma (MPM), and there are no validated prognostic factors that could be used preoperatively. We investigated the calretinin and D2-40 expression and the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation as potential preoperative prognostic factors.

Methods: Consecutive patients who underwent EPP were included in this retrospective study. Potential prognostic factors such as age, gender, histological subtype, baseline laboratory parameters including NLR, and immunohistochemical staining for calretinin and D2-40 were evaluated. Overall survival (OS) from the date of surgery was determined by the Kaplan-Meier method. The prognostic value of the variables was examined using Cox regression, and significant factors (p < 0.05) were entered into a multivariate model to determine their independent effect.

Results: A total of 85 patients were included: median age 58 years; 80% men; 77% epithelial and 23% biphasic MPM. The median OS was 19.7 months. The following variables were predictive of longer OS: female gender (p = 0.02), epithelial subtype (p = 0.04), low NLR (p < 0.01), and high calretinin score (p < 0.001). In a multivariate analysis, only NLR >/=3 (hazard ratio 1.79; 95% confidence interval: 1.04-3.07; p = 0.04) and calretinin score </=33 versus more than 67% (hazard ratio 4.72; 95% confidence interval: 1.97-11.32; p < 0.01) remained independent predictors. The addition of calretinin score increased the explained variation by 10.1%.

Conclusions: Both low calretinin expression and high NLR were independently associated with poor prognosis in patients with MPM undergoing EPP, and the calretinin score seemed to improve the accuracy of the prognostic model.

Original languageEnglish
Pages (from-to)1923-1929
Number of pages7
JournalJournal of Thoracic Oncology
Volume6
Issue number11
DOIs
Publication statusPublished - Nov 2011

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Calbindin 2
Pneumonectomy
Neutrophils
Lymphocytes
Confidence Intervals
Mesothelioma
Malignant Mesothelioma
Staining and Labeling
Survival

Cite this

Kao, Steven ; Klebe, Sonja ; Henderson, Douglas ; Reid, Glen ; Chatfield, Mark ; Armstrong, Nicola ; Yan, Tristan ; Vardy, Janette ; Clarke, Stephen ; van Zandwijk, Nico ; McCaughan, Brian. / Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy. In: Journal of Thoracic Oncology. 2011 ; Vol. 6, No. 11. pp. 1923-1929.
@article{843dd1b05c3a412496e2a867301be40d,
title = "Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy",
abstract = "Introduction: Survival after extrapleural pneumonectomy (EPP) is variable in patients with malignant pleural mesothelioma (MPM), and there are no validated prognostic factors that could be used preoperatively. We investigated the calretinin and D2-40 expression and the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation as potential preoperative prognostic factors. Methods: Consecutive patients who underwent EPP were included in this retrospective study. Potential prognostic factors such as age, gender, histological subtype, baseline laboratory parameters including NLR, and immunohistochemical staining for calretinin and D2-40 were evaluated. Overall survival (OS) from the date of surgery was determined by the Kaplan-Meier method. The prognostic value of the variables was examined using Cox regression, and significant factors (p < 0.05) were entered into a multivariate model to determine their independent effect. Results: A total of 85 patients were included: median age 58 years; 80{\%} men; 77{\%} epithelial and 23{\%} biphasic MPM. The median OS was 19.7 months. The following variables were predictive of longer OS: female gender (p = 0.02), epithelial subtype (p = 0.04), low NLR (p < 0.01), and high calretinin score (p < 0.001). In a multivariate analysis, only NLR >/=3 (hazard ratio 1.79; 95{\%} confidence interval: 1.04-3.07; p = 0.04) and calretinin score </=33 versus more than 67{\%} (hazard ratio 4.72; 95{\%} confidence interval: 1.97-11.32; p < 0.01) remained independent predictors. The addition of calretinin score increased the explained variation by 10.1{\%}. Conclusions: Both low calretinin expression and high NLR were independently associated with poor prognosis in patients with MPM undergoing EPP, and the calretinin score seemed to improve the accuracy of the prognostic model.",
author = "Steven Kao and Sonja Klebe and Douglas Henderson and Glen Reid and Mark Chatfield and Nicola Armstrong and Tristan Yan and Janette Vardy and Stephen Clarke and {van Zandwijk}, Nico and Brian McCaughan",
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Kao, S, Klebe, S, Henderson, D, Reid, G, Chatfield, M, Armstrong, N, Yan, T, Vardy, J, Clarke, S, van Zandwijk, N & McCaughan, B 2011, 'Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy', Journal of Thoracic Oncology, vol. 6, no. 11, pp. 1923-1929. https://doi.org/10.1097/JTO.0b013e31822a3740

Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy. / Kao, Steven; Klebe, Sonja; Henderson, Douglas; Reid, Glen; Chatfield, Mark; Armstrong, Nicola; Yan, Tristan; Vardy, Janette; Clarke, Stephen; van Zandwijk, Nico; McCaughan, Brian.

In: Journal of Thoracic Oncology, Vol. 6, No. 11, 11.2011, p. 1923-1929.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy

AU - Kao, Steven

AU - Klebe, Sonja

AU - Henderson, Douglas

AU - Reid, Glen

AU - Chatfield, Mark

AU - Armstrong, Nicola

AU - Yan, Tristan

AU - Vardy, Janette

AU - Clarke, Stephen

AU - van Zandwijk, Nico

AU - McCaughan, Brian

PY - 2011/11

Y1 - 2011/11

N2 - Introduction: Survival after extrapleural pneumonectomy (EPP) is variable in patients with malignant pleural mesothelioma (MPM), and there are no validated prognostic factors that could be used preoperatively. We investigated the calretinin and D2-40 expression and the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation as potential preoperative prognostic factors. Methods: Consecutive patients who underwent EPP were included in this retrospective study. Potential prognostic factors such as age, gender, histological subtype, baseline laboratory parameters including NLR, and immunohistochemical staining for calretinin and D2-40 were evaluated. Overall survival (OS) from the date of surgery was determined by the Kaplan-Meier method. The prognostic value of the variables was examined using Cox regression, and significant factors (p < 0.05) were entered into a multivariate model to determine their independent effect. Results: A total of 85 patients were included: median age 58 years; 80% men; 77% epithelial and 23% biphasic MPM. The median OS was 19.7 months. The following variables were predictive of longer OS: female gender (p = 0.02), epithelial subtype (p = 0.04), low NLR (p < 0.01), and high calretinin score (p < 0.001). In a multivariate analysis, only NLR >/=3 (hazard ratio 1.79; 95% confidence interval: 1.04-3.07; p = 0.04) and calretinin score </=33 versus more than 67% (hazard ratio 4.72; 95% confidence interval: 1.97-11.32; p < 0.01) remained independent predictors. The addition of calretinin score increased the explained variation by 10.1%. Conclusions: Both low calretinin expression and high NLR were independently associated with poor prognosis in patients with MPM undergoing EPP, and the calretinin score seemed to improve the accuracy of the prognostic model.

AB - Introduction: Survival after extrapleural pneumonectomy (EPP) is variable in patients with malignant pleural mesothelioma (MPM), and there are no validated prognostic factors that could be used preoperatively. We investigated the calretinin and D2-40 expression and the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation as potential preoperative prognostic factors. Methods: Consecutive patients who underwent EPP were included in this retrospective study. Potential prognostic factors such as age, gender, histological subtype, baseline laboratory parameters including NLR, and immunohistochemical staining for calretinin and D2-40 were evaluated. Overall survival (OS) from the date of surgery was determined by the Kaplan-Meier method. The prognostic value of the variables was examined using Cox regression, and significant factors (p < 0.05) were entered into a multivariate model to determine their independent effect. Results: A total of 85 patients were included: median age 58 years; 80% men; 77% epithelial and 23% biphasic MPM. The median OS was 19.7 months. The following variables were predictive of longer OS: female gender (p = 0.02), epithelial subtype (p = 0.04), low NLR (p < 0.01), and high calretinin score (p < 0.001). In a multivariate analysis, only NLR >/=3 (hazard ratio 1.79; 95% confidence interval: 1.04-3.07; p = 0.04) and calretinin score </=33 versus more than 67% (hazard ratio 4.72; 95% confidence interval: 1.97-11.32; p < 0.01) remained independent predictors. The addition of calretinin score increased the explained variation by 10.1%. Conclusions: Both low calretinin expression and high NLR were independently associated with poor prognosis in patients with MPM undergoing EPP, and the calretinin score seemed to improve the accuracy of the prognostic model.

U2 - 10.1097/JTO.0b013e31822a3740

DO - 10.1097/JTO.0b013e31822a3740

M3 - Article

VL - 6

SP - 1923

EP - 1929

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

IS - 11

ER -