BNP Ratio and Prognosis of Malignant Pleural Mesothelioma

A simple blood draw could help predict survival outcomes in patients with malignant pleural mesothelioma (MPM).

An observational study evaluated whether an increased pleural fluid-to-blood brain natriuretic peptide (BNP) ratio could help with prognosis in MPM. Vasiliki Tsolaki, MD, and colleagues created a survival curve using data from The Cancer Genome Atlas to examine 1- and 2-year survival.

Between January 2007 and October 2018, 19 patients with MPM were enrolled. The patients were mostly men (78.9%), and the mean age was 67 years. Ten patients had confirmed asbestos exposure, five had possible exposure, and four had unknown exposure.

Results of the study showed 1- and 2-year survival rates at 52.6% and 31.6%, respectively. Factors such as age, degree of pleural thickening, and performance status did not differ between survivors and nonsurvivors. All patients received chemotherapy, and no one underwent a surgical resection.

Nonsurvivors had higher pleural fluid BNP at 2 years and BNP ratios than survivors. In patients with BNP ratios above or equal to the median value of 8.82, the 1- and 2-year survival rates were 20% and 0%, respectively. In patients with BNP ratios below the median, 1-year survival was 88.9% and 2-year survival was 66.7%.

An analysis of the natriuretic peptide precursor B (NPPB) gene expression in MPM showed that patients with low NPPB expression had significantly higher survival rates compared with patients who had higher expressions.

“A high pleural fluid/blood BNP ratio, an easily performed in everyday practice, costless biomarker seems to predict poorer survival better than the commonly reported prognostic factors in MPM,” the authors concluded.