{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T03:24:01Z","timestamp":1770348241373,"version":"3.49.0"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis. Identifying reliable prognostic factors is crucial for risk stratification and optimizing treatment strategies. This study aimed to evaluate the impact of clinicopathologic factors and systemic inflammatory markers on survival outcomes in patients with MPM. Materials and Methods: This retrospective, multicenter study included 217 patients diagnosed with MPM between January 2009 and March 2024. Data on age, gender, histology, disease stage, treatment modalities, and inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein\/albumin ratio (CAR) were collected. Survival outcomes were analyzed using Kaplan\u2013Meier methods, and prognostic factors were evaluated using Cox regression analysis. Results: CAR was identified as an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). Patients with CAR &lt; 0.98 had significantly longer OS (87.0 months vs. 14.0 months, p &lt; 0.001) and PFS (17.61 months vs. 8.96 months, p = 0.010). While NLR was significant in univariate analysis (OS: 25.0 months for NLR &lt; 2.58 vs. 21.0 months for NLR \u2265 2.58, p = 0.040), it did not retain significance in the multivariate model (p = 0.180). Epithelioid histology and early-stage disease were strongly associated with improved survival outcomes (OS: 32.0 vs. 11.0 months for epithelioid vs. non-epithelioid histology, p &lt; 0.001; 32.0 vs. 12.0 months for early-stage vs. metastatic disease, p &lt; 0.001). Conclusions: CAR is a strong independent prognostic factor in MPM, reflecting systemic inflammation and nutritional status. Epithelioid histology and early-stage disease are associated with significantly longer survival, underscoring the critical role of early detection in improving patient outcomes.<\/jats:p>","DOI":"10.3390\/medicina61010144","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T06:46:10Z","timestamp":1737009970000},"page":"144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of Systemic Inflammation and Clinicopathologic Features on Survival in Malignant Pleural Mesothelioma: A Multicenter Analysis"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7312-3827","authenticated-orcid":false,"given":"Nadiye","family":"Sever","sequence":"first","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2423-6902","authenticated-orcid":false,"given":"Sedat","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Kartal Training and Research Hospital, \u0130stanbul 34865, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Fuat","family":"Gurbuz","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Necmettin Erbakan University, Konya 42090, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delyadil","family":"Karaka\u015f K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Dicle University Faculty of Medicine, Diyarbak\u0131r 21280, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esra","family":"Zeynelgil","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Ankara Ataturk Senatorium Training and Research Hospital, Ankara 06290, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-7350","authenticated-orcid":false,"given":"Yunus Emre","family":"Altinta\u015f","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Kartal Training and Research Hospital, \u0130stanbul 34865, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0410-003X","authenticated-orcid":false,"given":"Berivan Deniz","family":"\u00c7imik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye\u015fim","family":"A\u011fyol","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3562-5006","authenticated-orcid":false,"given":"Ali Kaan","family":"G\u00fcren","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u0131nar","family":"Erel","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erkam","family":"Kocaaslan","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Burak","family":"Pa\u00e7ac\u0131","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1537-3032","authenticated-orcid":false,"given":"Mustafa Alperen","family":"Tun\u00e7","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdussamet","family":"\u00c7elebi","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naz\u0131m Can","family":"Demircan","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, \u0130stanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selver","family":"I\u015f\u0131k","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rukiye","family":"Ar\u0131kan","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4632-9501","authenticated-orcid":false,"given":"Murat","family":"Araz","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Necmettin Erbakan University, Konya 42090, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serdar","family":"Karakaya","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Ankara Ataturk Senatorium Training and Research Hospital, Ankara 06290, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-1559","authenticated-orcid":false,"given":"Murat","family":"Sar\u0131","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, \u0130stanbul Medipol University, \u0130stanbul 34810, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osman","family":"K\u00f6stek","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, \u0130stanbul Medipol University, \u0130stanbul 34810, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-1084","authenticated-orcid":false,"given":"\u0130brahim Vedat","family":"Bayo\u011flu","sequence":"additional","affiliation":[{"name":"Medical Oncology, Department of Internal Medicine, Marmara University Faculty of Medicine, \u0130stanbul 34854, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","first-page":"260","article-title":"Diffuse pleural mesothelioma and asbestos exposure in the north western cape province","volume":"17","author":"Wagner","year":"1960","journal-title":"Br. J. Ind. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1200\/JCO.22.02542","article-title":"Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma","volume":"41","author":"Vogelzang","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/00130404-200311000-00008","article-title":"Promising early local control of malignant pleural mesothelioma following postoperative intensity modulated radiotherapy (IMRT) to the chest","volume":"9","author":"Ahamad","year":"2003","journal-title":"Cancer J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"743","DOI":"10.2147\/CLEP.S105396","article-title":"Mesothelioma in the United States: A surveillance, epidemiology, and end results (SEER)-medicare investigation of treatment patterns and overall survival","volume":"8","author":"Fryzek","year":"2016","journal-title":"Clin. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature07205","article-title":"Cancer-related inflammation","volume":"454","author":"Mantovani","year":"2008","journal-title":"Nature"},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"e31113","DOI":"10.1097\/MD.0000000000031113","article-title":"Pretreatment \u201cprognostic nutritional index\u201d as an indicator of outcome in lung cancer patients receiving ICI-based treatment: Systematic review and meta-analysis","volume":"101","author":"Shao","year":"2022","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/MCO.0b013e32832a7902","article-title":"Systemic inflammation, nutritional status and survival in patients with cancer","volume":"12","author":"McMillan","year":"2009","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1038\/sj.bjc.6601757","article-title":"Evaluation of a cumulative prognostic score based on the systemic inflammatory response in patients undergoing potentially curative surgery for colorectal cancer","volume":"90","author":"Canna","year":"2004","journal-title":"Br. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1038\/sj.bjc.6602998","article-title":"Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer","volume":"94","author":"Crumley","year":"2006","journal-title":"Br. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1159\/000321014","article-title":"The glasgow prognostic score is a good predictor of treatment outcome in patients with unresectable pancreatic cancer","volume":"56","author":"Shimoda","year":"2010","journal-title":"Chemotherapy"},{"key":"ref_12","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\u2014A novel view on inflammation. Cancers, 13.","DOI":"10.3390\/cancers13040658"},{"key":"ref_13","first-page":"2340","article-title":"Prognostic significance of inflammation scores in malignant mesothelioma","volume":"28","author":"Mutlu","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_14","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_15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.5606\/tgkdc.dergisi.2023.23365","article-title":"Prognostic factors and the prognostic role of inflammation indices in malignant pleural mesothelioma","volume":"31","author":"Ebinc","year":"2023","journal-title":"Turk. J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"98135","DOI":"10.18632\/oncotarget.20990","article-title":"Prognostic value of the c-reactive protein\/albumin ratio (CAR) in patients with operable soft tissue sarcoma","volume":"8","author":"Liang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sproston, N.R., and Ashworth, J.J. (2018). Role of c-reactive protein at sites of inflammation and infection. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.00754"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e048324","DOI":"10.1136\/bmjopen-2020-048324","article-title":"Inflammation and nutrition-based biomarkers in the prognosis of oesophageal cancer: A systematic review and meta-analysis","volume":"11","author":"Jiang","year":"2021","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Buonacera, A., Stancanelli, B., Colaci, M., and Malatino, L. (2022). Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23073636"},{"key":"ref_20","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_21","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_22","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_23","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1378\/chest.124.5.1916","article-title":"Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma","volume":"124","author":"Edwards","year":"2003","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1038\/bjc.2012.245","article-title":"Prognosis and prognostic factors of patients with mesothelioma: A population-based study","volume":"107","author":"Koffijberg","year":"2012","journal-title":"Br. J. Cancer"},{"key":"ref_25","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_26","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_27","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1002\/cncr.24886","article-title":"Proposed adjustments to pathologic staging of epithelial malignant pleural mesothelioma based on analysis of 354 cases","volume":"116","author":"Richards","year":"2010","journal-title":"Cancer"},{"key":"ref_28","first-page":"2073","article-title":"Survival in good performance malignant pleural mesothelioma patients; prognostic factors and predictors of response","volume":"18","author":"Rahouma","year":"2017","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1136\/thoraxjnl-2021-217709","article-title":"Incidence, treatment and survival of malignant pleural and peritoneal mesothelioma: A population-based study","volume":"77","author":"Belderbos","year":"2022","journal-title":"Thorax"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:29:54Z","timestamp":1759919394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010144"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010144","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}