Prognostic Significance of Inflammatory, Cellular, and Tumor-Specific Biomarkers in Patients With Pleural and Peritoneal Mesothelioma.

BACKGROUND

Mesothelioma is an aggressive malignancy with poor outcomes, particularly when diagnosed at advanced stages. This study evaluated the prognostic value of tumor-specific biomarkers: soluble mesothelin-related peptide (SMRP), megakaryocyte potentiating factor (MPF) and CA125; inflammatory markers: C-reactive protein (CRP) and fibrinogen; cellular markers: platelet count and neutrophil-to-lymphocyte ratio (NLR) in patients with pleural (MPM) and peritoneal mesothelioma (MPeM).

METHODS

A total of 414 patients including 241 MPM, 153 MPeM and 20 with mesothelioma at other body sites were enrolled in the Natural History Protocol (NCT01950572) at the National Cancer Institute. Blood samples collected at enrollment were assessed for biomarker levels and based on their expression levels patients were stratified into quartiles. Kaplan-Meier survival curves were plotted, and median overall survival (mOS) was compared between groups.

RESULTS

For all the biomarkers evaluated, there was a significant decrease in mOS in the high expression cohorts. The mOS in years in low versus high expression cohorts being: SMRP (3 vs. 0.7), MPF (3.7 vs. 0.7), CA125 (1.6 vs. 0.8), CRP (4.1 vs. 0.4), fibrinogen (4.1 vs. 0.6), platelet count (1.4 vs. 0.8) and NLR (2.1 vs. 0.7). When analyzed separately, the pleural and peritoneal cohorts showed similar trends. Strong correlations existed between SMRP and MPF (r = 0.84), as well as CRP and fibrinogen (r = 0.86).

CONCLUSIONS

Biomarkers such as SMRP, MPF, CA125, CRP, fibrinogen, platelet count and NLR can independently predict overall survival in mesothelioma. These biomarkers can therefore provide prognostic information for these patients and help guide treatment strategies.