{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T08:47:36Z","timestamp":1776329256487,"version":"3.50.1"},"reference-count":79,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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. Methods: 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)\u2014consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen\u2014was 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. Results: Median overall survival (OS) was 14 months for the entire cohort (95% CI: 11.4\u201316.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6\u201326.0; p &lt; 0.001). In multivariable analysis, MSIS (p &lt; 0.001), disease stage (p = 0.001), and the type of treatment (p = 0.004) were confirmed as independent predictors for OS. Higher MSIS was associated with shorter OS (p &lt; 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (\u2264 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\u201335.3] vs. 14.4 months [95% CI: 10.4\u201318.4], p &lt; 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\u201315.3] vs. 8.2 months [95% CI: 5.2\u201311.3], p = 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort (p &lt; 0.001). Conclusions: 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.<\/jats:p>","DOI":"10.3390\/cancers17081371","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:15:06Z","timestamp":1745180106000},"page":"1371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit of Multimodality Treatment in Pleural Mesothelioma"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9805-9733","authenticated-orcid":false,"given":"Berta","family":"Mosleh","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Sinn","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5211-382X","authenticated-orcid":false,"given":"Anna","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Reiner","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-8301","authenticated-orcid":false,"given":"Ariane","family":"Steindl","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-4126","authenticated-orcid":false,"given":"Christian","family":"Lang","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine II, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Z\u00f6chbauer-M\u00fcller","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Dieckmann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-6690","authenticated-orcid":false,"given":"Joachim","family":"Widder","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6119-6364","authenticated-orcid":false,"given":"Helmut","family":"Prosch","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8799-8624","authenticated-orcid":false,"given":"Balazs","family":"Dome","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"National Koranyi Institute of Pulmonology, 1121 Budapest, Hungary"},{"name":"Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Schelch","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Center for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7787-991X","authenticated-orcid":false,"given":"Clemens","family":"Aigner","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Klikovits","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, 1210 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6330-1951","authenticated-orcid":false,"given":"Michal","family":"Benej","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, 1210 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4149-4890","authenticated-orcid":false,"given":"Stefan","family":"Watzka","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, 1210 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2847-4534","authenticated-orcid":false,"given":"Martin","family":"Filipits","sequence":"additional","affiliation":[{"name":"Center for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-5957","authenticated-orcid":false,"given":"Servet","family":"B\u00f6l\u00fckbas","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavla","family":"Sarova","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine II, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Gompelmann","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine II, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5486-9340","authenticated-orcid":false,"given":"Michael","family":"Grusch","sequence":"additional","affiliation":[{"name":"Center for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7088-8768","authenticated-orcid":false,"given":"Mir Alireza","family":"Hoda","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"key":"ref_1","first-page":"491","article-title":"Malignant pleural mesothelioma: An epidemiological perspective","volume":"1","author":"Robinson","year":"2012","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Brims, F. (2021). Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma. Cancers, 13.","DOI":"10.3390\/cancers13164194"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1097\/JTO.0b013e31826915f1","article-title":"Initial analysis of the international association for the study of lung cancer mesothelioma database","volume":"7","author":"Rusch","year":"2012","journal-title":"J. Thorac. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/j.jtho.2016.09.124","article-title":"The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma","volume":"11","author":"Rusch","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1093\/carcin\/bgz004","article-title":"Prognostic factors of survival in patients with malignant pleural mesothelioma: An analysis of the National Cancer Database","volume":"40","author":"Alpert","year":"2019","journal-title":"Carcinogenesis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1038\/bjc.2014.478","article-title":"Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales","volume":"111","author":"Linton","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/jjco\/hyq159","article-title":"Survival and prognostic factors in malignant pleural mesothelioma: A retrospective study of 314 patients in the west part of Japan","volume":"41","author":"Nojiri","year":"2011","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1136\/thorax.55.9.731","article-title":"Prognostic factors for malignant mesothelioma in 142 patients: Validation of CALGB and EORTC prognostic scoring systems","volume":"55","author":"Edwards","year":"2000","journal-title":"Thorax"},{"key":"ref_9","first-page":"449","article-title":"Biomarkers and prognostic factors for mesothelioma","volume":"1","author":"Pass","year":"2012","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3973","DOI":"10.2147\/CMAR.S201269","article-title":"High systemic immune-inflammation index represents an unfavorable prognosis of malignant pleural mesothelioma","volume":"11","author":"Ma","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2782590","DOI":"10.1155\/2017\/2782590","article-title":"Life Expectancy in Pleural and Peritoneal Mesothelioma","volume":"2017","author":"Shavelle","year":"2017","journal-title":"Lung Cancer Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1097\/JTO.0b013e3181f1cf2b","article-title":"Malignant pleural mesothelioma: A population-based study of survival","volume":"5","author":"Milano","year":"2010","journal-title":"J. Thorac. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/ijc.23874","article-title":"Survival of pleural malignant mesothelioma in Italy: A population-based study","volume":"124","author":"Montanaro","year":"2009","journal-title":"Int. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.1759-7714.2012.00127.x","article-title":"Clinical and biologic prognostic factors in malignant pleural mesothelioma","volume":"3","author":"Ambrogi","year":"2012","journal-title":"Thorac. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.21037\/jtd.2016.07.55","article-title":"Validation of EORTC and CALGB prognostic models in surgical patients submitted to diagnostic, palliative or curative surgery for malignant pleural mesothelioma","volume":"8","author":"Sandri","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Fu, X., Li, T., Dai, Y., and Li, J. (2019). Preoperative systemic inflammation score (SIS) is superior to neutrophil to lymphocyte ratio (NLR) as a predicting indicator in patients with esophageal squamous cell carcinoma. BMC Cancer, 19.","DOI":"10.1186\/s12885-019-5940-6"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s12199-016-0530-6","article-title":"Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma","volume":"21","author":"Tanrikulu","year":"2016","journal-title":"Environ. Health Prev. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1038\/bjc.2013.815","article-title":"Circulating fibrinogen is a prognostic and predictive biomarker in malignant pleural mesothelioma","volume":"110","author":"Ghanim","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2217\/fon.15.317","article-title":"Biomarkers and prognostic factors for malignant pleural mesothelioma","volume":"11","author":"Vigneri","year":"2015","journal-title":"Future Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ejca.2016.04.018","article-title":"Circulating activin A is a novel prognostic biomarker in malignant pleural mesothelioma\u2013A multi-institutional study","volume":"63","author":"Hoda","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"259","DOI":"10.21037\/tlcr.2017.05.06","article-title":"Diagnostic and prognostic biomarkers for malignant mesothelioma: An update","volume":"6","author":"Chen","year":"2017","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1016\/j.athoracsur.2014.05.071","article-title":"Extrapleural pneumonectomy after induction chemotherapy: Perioperative outcome in 251 mesothelioma patients from three high-volume institutions","volume":"98","author":"Lauk","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJMoa1115050","article-title":"Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma","volume":"367","author":"Pass","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1038\/bjc.2015.286","article-title":"Fibulin-3 levels in malignant pleural mesothelioma are associated with prognosis but not diagnosis","volume":"113","author":"Kirschner","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/SLA.0b013e3182602af4","article-title":"Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: A retrospective multicenter analysis","volume":"256","author":"Ghanim","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.lungcan.2022.05.018","article-title":"A prognostic score for patients with malignant pleural mesothelioma (MPM) receiving second-line immunotherapy or chemotherapy in the ETOP 9\u201315 PROMISE-meso phase III trial","volume":"169","author":"Banna","year":"2022","journal-title":"Lung Cancer"},{"key":"ref_27","first-page":"651","article-title":"Are neutrophil\/lymphocyte ratio and platelet\/lymphocyte ratio reliable parameters as prognostic indicators in malignant mesothelioma?","volume":"12","author":"Sokucu","year":"2016","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"57460","DOI":"10.18632\/oncotarget.15404","article-title":"Prognostic significance of neutrophil-to-lymphocyte ratio in patients with malignant pleural mesothelioma: A meta-analysis","volume":"8","author":"Chen","year":"2017","journal-title":"Oncotarget"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bugada, D., Allegri, M., Lavand\u2019homme, P., De Kock, M., and Fanelli, G. (2014). Inflammation-based scores: A new method for patient-targeted strategies and improved perioperative outcome in cancer patients. Biomed Res. Int., 2014.","DOI":"10.1155\/2014\/142425"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.cca.2018.05.059","article-title":"Preoperative increased systemic immune-inflammation index predicts poor prognosis in patients with operable non-small cell lung cancer","volume":"484","author":"Gao","year":"2018","journal-title":"Clin. Chim. Acta"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1002\/jcp.27052","article-title":"The predictive value of a preoperative systemic immune-inflammation index and prognostic nutritional index in patients with esophageal squamous cell carcinoma","volume":"234","author":"Zhang","year":"2019","journal-title":"J. Cell. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"849","DOI":"10.2147\/CMAR.S151026","article-title":"Systemic immune-inflammation index as a useful prognostic indicator predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy","volume":"9","author":"Chen","year":"2017","journal-title":"Cancer Manag. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"54564","DOI":"10.18632\/oncotarget.10515","article-title":"Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib","volume":"7","author":"Lolli","year":"2016","journal-title":"Oncotarget"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1007\/s00345-021-03715-4","article-title":"Role of systemic immune-inflammation index in patients treated with salvage radical prostatectomy","volume":"39","author":"Rajwa","year":"2021","journal-title":"World J. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/SLA.0000000000003370","article-title":"High Systemic Immune-Inflammation Index is an Adverse Prognostic Factor for Patients With Gastroesophageal Adenocarcinoma","volume":"273","author":"Jomrich","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.7150\/jca.29319","article-title":"Comparison of the Prognostic Value of Systemic Inflammation Response Markers in Small Cell Lung Cancer Patients","volume":"10","author":"Zhou","year":"2019","journal-title":"J. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e13788","DOI":"10.1097\/MD.0000000000013788","article-title":"Systemic immune-inflammation index is a promising noninvasive marker to predict survival of lung cancer: A meta-analysis","volume":"98","author":"Zhang","year":"2019","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zhang, H., Zhang, L., Zhu, K., Shi, B., Yin, Y., Zhu, J., Yue, D., Zhang, B., and Wang, C. (2015). Prognostic Significance of Combination of Preoperative Platelet Count and Neutrophil-Lymphocyte Ratio (COP-NLR) in Patients with Non-Small Cell Lung Cancer: Based on a Large Cohort Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0126496"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1016\/j.jtho.2016.09.121","article-title":"The IASLC Mesothelioma Staging Project: Proposals for Revisions of the N Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma","volume":"11","author":"Rice","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1016\/j.jtho.2016.08.147","article-title":"The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma","volume":"11","author":"Nowak","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/j.jtho.2016.09.123","article-title":"The IASLC Mesothelioma Staging Project: Improving Staging of a Rare Disease Through International Participation","volume":"11","author":"Pass","year":"2016","journal-title":"J. Thorac. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3904","DOI":"10.7150\/jca.26360","article-title":"Prognostic Value of Plasma Fibrinogen in Lung Cancer Patients: A Meta-Analysis","volume":"9","author":"Zhong","year":"2018","journal-title":"J. Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1038\/bjc.2013.504","article-title":"Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma","volume":"109","author":"Meniawy","year":"2013","journal-title":"Br. J. Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Vogl, M., Rosenmayr, A., Bohanes, T., Scheed, A., Brndiar, M., Stubenberger, E., and Ghanim, B. (2021). Biomarkers for Malignant Pleural Mesothelioma-A Novel View on Inflammation. Cancers, 13.","DOI":"10.3390\/cancers13040658"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Zhou, X., Du, Y., Huang, Z., Xu, J., Qiu, T., Wang, J., Wang, T., Zhu, W., and Liu, P. (2014). Prognostic value of PLR in various cancers: A meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0101119"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"6857","DOI":"10.2147\/OTT.S115631","article-title":"FAS and FASL genetic polymorphisms impact on clinical outcome of malignant pleural mesothelioma","volume":"9","author":"Ghali","year":"2016","journal-title":"Onco Targets Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"244","DOI":"10.21037\/atm.2017.06.60","article-title":"Diagnosis and prognosis-review of biomarkers for mesothelioma","volume":"5","author":"Sun","year":"2017","journal-title":"Ann. Transl. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ctrv.2015.05.001","article-title":"The established and future biomarkers of malignant pleural mesothelioma","volume":"41","author":"Panou","year":"2015","journal-title":"Cancer Treat. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e142","DOI":"10.1016\/j.cllc.2019.10.013","article-title":"Elevated Circulating Activin A Levels in Patients With Malignant Pleural Mesothelioma Are Related to Cancer Cachexia and Reduced Response to Platinum-based Chemotherapy","volume":"21","author":"Paajanen","year":"2020","journal-title":"Clin. Lung Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/JTO.0b013e31815608d9","article-title":"Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center","volume":"2","author":"Flores","year":"2007","journal-title":"J. Thorac. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1016\/j.ejca.2009.04.028","article-title":"A prognostic index for progression-free survival in malignant mesothelioma with application to the design of phase II trials: A combined analysis of 10 EORTC trials","volume":"45","author":"Francart","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kotecha, R., Tonse, R., Rubens, M., Appel, H., Albrecht, F., Kaywin, P., Alley, E.W., Tom, M.C., and Mehta, M.P. (2021). Meta-Analysis of Survival and Development of a Prognostic Nomogram for Malignant Pleural Mesothelioma Treated with Systemic Chemotherapy. Cancers, 13.","DOI":"10.3390\/cancers13092186"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.jtho.2021.12.014","article-title":"The 2021 WHO Classification of Tumors of the Pleura: Advances Since the 2015 Classification","volume":"17","author":"Sauter","year":"2022","journal-title":"J. Thorac. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Mastromarino, M.G., Lenzini, A., Aprile, V., Ali, G., Bacchin, D., Korasidis, S., Ambrogi, M.C., and Lucchi, M. (2022). New Insights in Pleural Mesothelioma Classification Update: Diagnostic Traps and Prognostic Implications. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122905"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jtho.2018.07.002","article-title":"Pathologic Grading of Malignant Pleural Mesothelioma: An Evidence-Based Proposal","volume":"13","author":"Pelosi","year":"2018","journal-title":"J. Thorac. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1038\/modpathol.2017.170","article-title":"Nuclear grade and necrosis predict prognosis in malignant epithelioid pleural mesothelioma: A multi-institutional study","volume":"31","author":"Rosen","year":"2018","journal-title":"Mod. Pathol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4149\/neo_2017_114","article-title":"Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma","volume":"64","author":"Zhang","year":"2017","journal-title":"Neoplasma"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1186\/s12957-015-0710-7","article-title":"Preoperative neutrophil\/lymphocyte ratio and prognostic nutritional index predict survival in patients with non-small cell lung cancer","volume":"13","author":"Shimizu","year":"2015","journal-title":"World J. Surg. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s10654-021-00752-6","article-title":"Systemic inflammation markers and cancer incidence in the UK Biobank","volume":"36","author":"Nost","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"5769","DOI":"10.2147\/JIR.S334941","article-title":"The Efficacy of Different Inflammatory Markers for the Prognosis of Patients with Malignant Tumors","volume":"14","author":"Zheng","year":"2021","journal-title":"J. Inflamm. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"5805","DOI":"10.1158\/1078-0432.CCR-10-2245","article-title":"High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy","volume":"16","author":"Kao","year":"2010","journal-title":"Clin. Cancer Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/JTO.0b013e31823f45c1","article-title":"Inflammation-based prognostic indices in malignant pleural mesothelioma","volume":"7","author":"Pinato","year":"2012","journal-title":"J. Thorac. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.7314\/APJCP.2014.15.5.2061","article-title":"Relationship between prognosis and neutrophil: Lymphocyte and platelet:lymphocyte ratios in patients with malignant pleural mesotheliomas","volume":"15","author":"Cihan","year":"2014","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1097\/JTO.0b013e31822a3740","article-title":"Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy","volume":"6","author":"Kao","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10120-018-0854-6","article-title":"Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer","volume":"22","author":"Lin","year":"2019","journal-title":"Gastric Cancer"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1245\/s10434-018-6385-x","article-title":"The C-Reactive Protein\/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study","volume":"25","author":"Takamori","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_67","first-page":"445","article-title":"Prognostic Impact of Inflammation-related Biomarkers on Overall Survival of Patients with Inoperable Malignant Pleural Mesothelioma","volume":"32","author":"Otoshi","year":"2018","journal-title":"In Vivo"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"101813","DOI":"10.1016\/j.suronc.2022.101813","article-title":"Prognostic values of preoperative C-reactive protein, albumin, and neutrophil ratios in patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy","volume":"43","author":"Okita","year":"2022","journal-title":"Surg. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Greb, D., Hebeisen, M., Matter, A., Opitz, I., and Lauk, O. (2022). Prospective validation and extension of the Multimodality Prognostic Score for the treatment allocation of pleural mesothelioma patients. Eur. J. Cardiothorac. Surg., 62.","DOI":"10.1093\/ejcts\/ezac085"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1097\/JTO.0000000000000661","article-title":"A New Prognostic Score Supporting Treatment Allocation for Multimodality Therapy for Malignant Pleural Mesothelioma: A Review of 12 Years\u2019 Experience","volume":"10","author":"Opitz","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"210057","DOI":"10.1183\/16000617.0057-2021","article-title":"Clinical utility of diagnostic biomarkers in malignant pleural mesothelioma: A systematic review and meta-analysis","volume":"30","author":"Schillebeeckx","year":"2021","journal-title":"Eur. Respir. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/S1470-2045(20)30606-9","article-title":"Surgery for malignant pleural mesothelioma after radiotherapy (SMART): Final results from a single-centre, phase 2 trial","volume":"22","author":"Cho","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/S1470-2045(11)70149-8","article-title":"Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: Clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study","volume":"12","author":"Treasure","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e038892","DOI":"10.1136\/bmjopen-2020-038892","article-title":"Mesothelioma and Radical Surgery 2 (MARS 2): Protocol for a multicentre randomised trial comparing (extended) pleurectomy decortication versus no (extended) pleurectomy decortication for patients with malignant pleural mesothelioma","volume":"10","author":"Lim","year":"2020","journal-title":"BMJ Open"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"562","DOI":"10.21037\/tlcr.2018.10.02","article-title":"Combined modality treatment in mesothelioma: A systemic literature review with treatment recommendations","volume":"7","author":"Psallidas","year":"2018","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Strbac, D., and Dolzan, V. (2022). Novel and Future Treatment Options in Mesothelioma: A Systematic Review. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23041975"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1900953","DOI":"10.1183\/13993003.00953-2019","article-title":"ERS\/ESTS\/EACTS\/ESTRO guidelines for the management of malignant pleural mesothelioma","volume":"55","author":"Scherpereel","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Cantini, L., Hassan, R., Sterman, D.H., and Aerts, J. (2020). Emerging Treatments for Malignant Pleural Mesothelioma: Where Are We Heading?. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00343"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1158\/1055-9965.EPI-20-0083","article-title":"Mesothelioma Biomarkers: A Review Highlighting Contributions from the Early Detection Research Network","volume":"29","author":"Pass","year":"2020","journal-title":"Cancer Epidemiol. Biomarkers Prev."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1371\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:18:17Z","timestamp":1760030297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,20]]},"references-count":79,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["cancers17081371"],"URL":"https:\/\/doi.org\/10.3390\/cancers17081371","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,20]]}}}