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)—consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen—was 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: 11.4–16.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6–26.0;p< 0.001). In multivariable analysis, MSIS (p< 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< 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (≤ 2) MSIS, multimodality therapy was associated with significantly prolonged OS when compared with chemo- and/or radiotherapy alone (25.8 months [95% CI: 16.4–35.3] vs. 14.4 months [95% CI: 10.4–18.4],p< 0.001). In contrast, among patients with elevated MSIS, no survival benefit was achieved by surgery over conservative treatment (11.8 months [95% CI: 8.3–15.3] vs. 8.2 months [95% CI: 5.2–11.3],p= 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort (p< 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.
背景/目的：恶性胸膜间皮瘤（MPM）的治疗仍具挑战性，预后较差。在临床管理策略尚存争议的背景下，亟需能够筛选患者并预测其从特定治疗方案中获益的生物标志物。方法：本研究对奥地利维也纳医科大学胸外科1994年至2020年间收治的195例患者进行回顾性分析，评估了由治疗前中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）、C反应蛋白（CRP）和纤维蛋白原构成的间皮瘤全身炎症评分（MSIS）的预后及预测价值。随后，在奥地利维也纳弗洛里茨多夫医院卡尔·兰德施泰纳临床与转化胸外科研究所胸外科收治的80例独立患者队列中对MSIS的预后影响进行了验证。结果：整个队列的中位总生存期（OS）为14个月（95% CI：11.4–16.6）。接受包含肉眼完全切除在内的多模式治疗的患者OS更长（22.3个月，95% CI：18.6–26.0；p < 0.001）。在多变量分析中，MSIS（p < 0.001）、疾病分期（p = 0.001）和治疗类型（p = 0.004）被确认为OS的独立预测因子。较高的MSIS与较短的OS相关（p < 0.001）。包含手术在内的多模式治疗方案带来的显著生存获益仅限于MSIS较低的患者。在MSIS低（≤ 2）的患者中，与单纯化疗和/或放疗相比，多模式治疗与OS显著延长相关（25.8个月 [95% CI：16.4–35.3] vs. 14.4个月 [95% CI：10.4–18.4]，p < 0.001）。相比之下，在MSIS升高的患者中，手术相比保守治疗并未带来生存获益（11.8个月 [95% CI：8.3–15.3] vs. 8.2个月 [95% CI：5.2–11.3]，p = 0.233）。MSIS预测生存的能力在基线队列和独立验证队列中表现一致（p < 0.001）。结论：间皮瘤全身炎症评分是胸膜间皮瘤的一个独立预后评分，能够预测特定患者从作为多模式治疗一部分的肉眼完全切除术中获益。
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