{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:37:58Z","timestamp":1790739478241,"version":"4.1.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T00:00:00Z","timestamp":1651276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T00:00:00Z","timestamp":1651276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Consecutive patients diagnosed with biopsy-proven MPM were prospectively recruited to an observational cohort study and followed up for a minimum of 7.5\u00a0years. 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>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\u2009&lt;\u20094) inferred a better prognosis with a median survival of 420\u00a0days versus 301\u00a0days (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Survival was better for patients with a lymphocyte-predominant pleural effusion (430 vs 306\u00a0days, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Lymphocyte infiltration of tumour stroma was also associated with improved survival (n\u2009=\u200992, survival 430\u00a0days) compared with neutrophilic or acellular samples (n\u2009=\u200926, survival 342\u00a0days <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). In multivariable modelling lymphocyte predominance in blood, pleural fluid and tumour stroma were all associated with a better prognosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Lymphocyte predominance within tumour stroma, pleural fluid or blood infers a better prognosis in patients with MPM.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-022-01968-2","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T14:13:43Z","timestamp":1651500823000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Lymphocyte predominance in blood, pleural fluid, and tumour stroma; a prognostic marker in pleural mesothelioma"],"prefix":"10.1186","volume":"22","author":[{"given":"Duneesha","family":"De Fonseka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna J.","family":"Morley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Brett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Edey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Daly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna C.","family":"Bibby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick A.","family":"Maskell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,30]]},"reference":[{"issue":"Suppl 1","key":"1968_CR1","doi-asserted-by":"publisher","first-page":"i1","DOI":"10.1136\/thoraxjnl-2017-211321","volume":"73","author":"I Woolhouse","year":"2018","unstructured":"Woolhouse I, Bishop L, Darlison L, De Fonseka D, Edey A, Edwards J, et al. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018;73(Suppl 1):i1\u201330.","journal-title":"Thorax"},{"issue":"7","key":"1968_CR2","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1038\/bjc.2015.77","volume":"112","author":"DT Arnold","year":"2015","unstructured":"Arnold DT, Hooper CE, Morley A, White P, Lyburn ID, Searle J, et al. The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial. Br J Cancer. 2015;112(7):1183\u20139.","journal-title":"Br J Cancer"},{"issue":"10026","key":"1968_CR3","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/S0140-6736(15)01238-6","volume":"387","author":"G Zalcman","year":"2016","unstructured":"Zalcman G, Mazieres J, Margery J, Greillier L, Audigier-Valette C, Moro-Sibilot D, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016;387(10026):1405\u201314.","journal-title":"Lancet"},{"issue":"10272","key":"1968_CR4","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/S0140-6736(20)32714-8","volume":"397","author":"P Baas","year":"2021","unstructured":"Baas P, Scherpereel A, Nowak AK, Fujimoto N, Peters S, Tsao AS, et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. Lancet. 2021;397(10272):375\u201386.","journal-title":"Lancet"},{"issue":"12","key":"1968_CR5","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1007\/s00262-011-1073-8","volume":"60","author":"K Suzuki","year":"2011","unstructured":"Suzuki K, Kadota K, Sima CS, Sadelain M, Rusch VW, Travis WD, et al. Chronic inflammation in tumor stroma is an independent predictor of prolonged survival in epithelioid malignant pleural mesothelioma patients. Cancer Immunol Immunother. 2011;60(12):1721\u20138.","journal-title":"Cancer Immunol Immunother"},{"issue":"10","key":"1968_CR6","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1007\/s00262-010-0881-6","volume":"59","author":"N Yamada","year":"2010","unstructured":"Yamada N, Oizumi S, Kikuchi E, Shinagawa N, Konishi-Sakakibara J, Ishimine A, et al. CD8+ tumor-infiltrating lymphocytes predict favorable prognosis in malignant pleural mesothelioma after resection. Cancer Immunol Immunother. 2010;59(10):1543\u20139.","journal-title":"Cancer Immunol Immunother"},{"issue":"7","key":"1968_CR7","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1038\/bjc.2015.62","volume":"112","author":"CE Hooper","year":"2015","unstructured":"Hooper CE, Lyburn ID, Searle J, Darby M, Hall T, Hall D, et al. The South West Area Mesothelioma and Pemetrexed trial: a multicentre prospective observational study evaluating novel markers of chemotherapy response and prognostication. Br J Cancer. 2015;112(7):1175\u201382.","journal-title":"Br J Cancer"},{"issue":"6","key":"1968_CR8","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1093\/jnci\/dju124","volume":"106","author":"AJ Templeton","year":"2014","unstructured":"Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):124.","journal-title":"J Natl Cancer Inst."},{"issue":"23","key":"1968_CR9","doi-asserted-by":"publisher","first-page":"5805","DOI":"10.1158\/1078-0432.CCR-10-2245","volume":"16","author":"SC Kao","year":"2010","unstructured":"Kao SC, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N, et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010;16(23):5805\u201313.","journal-title":"Clin Cancer Res"},{"issue":"4","key":"1968_CR10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0250628","volume":"16","author":"N Popowicz","year":"2021","unstructured":"Popowicz N, Cheah HM, Gregory C, Miranda A, Dick IM, Lee YCG, et al. Neutrophil-to-lymphocyte ratio in malignant pleural fluid: prognostic significance. PLoS ONE. 2021;16(4): e0250628.","journal-title":"PLoS ONE"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-022-01968-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-022-01968-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-022-01968-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T14:15:19Z","timestamp":1651500919000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-022-01968-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,30]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["1968"],"URL":"https:\/\/doi.org\/10.1186\/s12890-022-01968-2","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,30]]},"assertion":[{"value":"25 November 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical review for the study was waived by the local research and ethics committee (North Somerset and South Bristol Research Ethics Committee then South West 3 REC) who felt that informed consent was not required for analysis of this routine data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"173"}}