Immunohistochemistry helps in the diagnosis of MPM. Calretinin is the most commonly used antibody with a reported sensitivity of 71% and specificity of 95%. Pleurectomy is considered as the best choice for the treatment of early stage disease. Two surgical techniques are available, Extended Pleurectomy/Decortication (EPD) and extrapleural pneumonectomy which is less tolerated. Patients with malignant pleural mesothelioma have a poor prognosis, with estimated median survival times varying from 4 to 12 months. Prognostic factors for survival of MPM according to European Organization for Research and Treatment of Cancer (EORTC) scoring system included performance status, white blood cell (WBC) count, gender, histologic subtype. Prognostic assessment methods that are easy to use, inexpensive, and effective are needed for those patients. Studies have identified the neutrophil to-lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) as measures of systemic inflammation; they provide reproducible, early detected markers that may be of valuable prognostic factors in patients with MPM. However, it is important to note that NLR can increase in many other non-malignant conditions.