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Factors Associated With Survival In A Large Series Of Patients With Malignant Pleural Mesothelioma In New South Wales
A. Linton, N. Pavlakis, R. O'Connell, M. Soeberg, S. Kao, S. Clarke, J. Vardy, N. van Zandwijk
Published 2014 · Medicine
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Background:Although the prognosis of most patients presenting with malignant pleural mesothelioma (MPM) is poor, a small proportion survives long term. We investigated factors associated with survival in a large patient series.Methods:All patients registered with the NSW Dust Diseases Board (2002–2009) were included in an analysis of prognostic factors using Kaplan–Meier and Cox regression analysis. On the basis of these analyses, we developed a risk score (Prognostic Index (PI)).Results:We identified 910 patients: 90% male; histology (epithelioid 60%; biphasic 13%; sarcomatoid 17%); stage (Tx-I-II 48%; III-IV 52%); and calretinin expression (91%). Treatment: chemotherapy(CT) 44%, and extrapleural-pneumonectomy (EPP) 6%. Median overall survival (OS) was 10.0 months. Longer OS was associated with: age <70 (13.5 vs 8.5 months; P<0.001); female gender (12.0 vs 9.9 months; P<0.001); epithelioid subtype (13.3 vs 6.2 months; P<0.001); ECOG status 0 (27.4 vs 9.7 months; P=0.015), calretinin expression (10.9 vs 5.5 months; P<0.001); neutrophil–lymphocyte ratio (NLR) <5 (11.9 vs 7.5 months; P<0.001); platelet count <400 (11.5 vs 7.2 months; P<0.001); and normal haemoglobin (16.4 vs 8.8 months; P<0.001). On time-dependent analysis, patients receiving pemetrexed-based chemotherapy (HR=0.83; P=0.048) or EPP (HR=0.41; P<0.001) had improved survival. Age, gender, histology, calretinin and haematological factors remained significant on multivariate analysis. In all, 24% of patients survived >20 months: 16% of these receiving EPP, and 66% CT. The PI offered improved prognostic discrimination over one of the existing prognostic models (EORTC).Conclusions:We identified calretinin expression, age, gender, histological subtype, platelet count and haemoglobin level as independent prognostic factors. Patients undergoing EPP or pemetrexed-based chemotherapy demonstrated better survival, but 84% and 34% of long survivors, respectively, did not receive radical surgery or chemotherapy.
This paper references
Prognostic features of long-term survivors after surgical management of malignant pleural mesothelioma.
T. Yan (2009)
Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma.
J. Friedberg (2012)
Malignant mesothelioma, hypoalbuminaemia and the effect of carboplatin/pemetrexed on survival.
S. Murphy (2013)
The meaning and use of the area under a receiver operating characteristic (ROC) curve.
J. Hanley (1982)
Australian Statistical Geography Standard (ASGS) Volume 5, Remoteness Areas Commonwealth of Australia
Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
N. Vogelzang (2003)
Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma.
W. Weder (2004)
Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience.
D. Curran (1998)
Illustrating the Impact of a Time-Varying Covariate With an Extended Kaplan-Meier Estimator
S. Snapinn (2005)
Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients.
R. Flores (2008)
Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors.
T. Yan (2009)
Population-based survival for malignant mesothelioma after introduction of novel chemotherapy
R. Damhuis (2011)
Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B.
J. Herndon (1998)
Relationship between 18 FDG PET-CT findings and the survival of 177 patients with malignant pleural mesothelioma.
A. Abakay (2013)
A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma
C. Cao (2010)
Improving survival results after surgical management of malignant pleural mesothelioma: an Australian institution experience.
T. Yan (2011)
Internal validation of predictive models: efficiency of some procedures for logistic regression analysis.
E. Steyerberg (2001)
Incidence and Survival of Malignant Pleural Mesothelioma in Norway: A Population-Based Study of 1686 Cases
Å. Helland (2012)
The trial of differentiation grading of epithelioid mesothelioma with reference to its clinicopathological significance (Abstr P10–1) Available at: http://imig.org/wp-content/uploads
Y Takeshima (2010)
Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma
T. Meniawy (2013)
J. Espinosa Arranz (1994)
Elevated tumour expression of miR-210 is associated with short survival in malignant pleural mesothelioma patients undergoing extrapleural pneumonectomy
MB Kirschner (2013)
Predicting survival in malignant mesothelioma
A. Musk (2011)
Utility of Osteopontin and Serum Mesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment
B. Grigoriu (2007)
The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma.
J. H. Schouwink (2003)
Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center
R. Flores (2007)
Pleurectomy/Decortication is Superior to Extrapleural Pneumonectomy in the Multimodality Management of Patients with Malignant Pleural Mesothelioma
L. Lang-Lazdunski (2012)
Population based epidemiology and prognosis of mesothelioma in Leeds, UK
A. Chapman (2008)
Excision repair cross complementation group 1 and thymidylate synthase expression in patients with mesothelioma.
S. Kao (2013)
Low Calretinin Expression and High Neutrophil-To-Lymphocyte Ratio Are Poor Prognostic Factors in Patients with Malignant Mesothelioma Undergoing Extrapleural Pneumonectomy
S. Kao (2011)
High Blood Neutrophil-to-Lymphocyte Ratio Is an Indicator of Poor Prognosis in Malignant Mesothelioma Patients Undergoing Systemic Therapy
S. Kao (2010)
J Clin Oncol
Statistical validation of the EORTC prognostic model for malignant pleural mesothelioma based on three consecutive phase II trials.
D. Fennell (2005)
An RNAi-based screen reveals PLK1, CDK1 and NDC80 as potential therapeutic targets in malignant pleural mesothelioma
A. Linton (2014)
The Mars trial: resolution of the surgical controversies in mesothelioma?
V. Rusch (2009)
Applied Logistic Regression.
A. Scott (1991)
The trial of differentiation grading of epithelioid mesothelioma with reference to its clinicopathological significance (Abstr P10–1)
Y Takeshima (2010)
Malignant mesothelioma. In Cancer Medicine, Holland JC, Frei E (eds) 5th edn, pp 1293–1312
AP Chahinian (2000)
Mesothelin-related predictive and prognostic factors in malignant mesothelioma: a nested case-control study.
O. Røe (2008)
Statistical validation of intermediate endpoints for chronic diseases.
L. Freedman (1992)
The ticking time-bomb of asbestos: its insidious role in the development of malignant mesothelioma.
Anthony Linton (2012)
A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma.
C. Cao (2014)
Recommendations for Uniform Definitions of Surgical Techniques for Malignant Pleural Mesothelioma: A Consensus Report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group
D. Rice (2011)
Calretinin is essential for mesothelioma cell growth/survival in vitro: A potential new target for malignant mesothelioma therapy?
Walter Blum (2013)
The MARS feasibility trial: conclusions not supported by data.
W. Weder (2011)
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
T. Treasure (2011)
Supplementary Information accompanies this paper on British Journal of Cancer website (http://www.nature.com/bjc) Prognostic factors in malignant mesothelioma BRITISH JOURNAL OF CANCER www
Presentation of multivariate data for clinical use: The Framingham Study risk score functions.
L. Sullivan (2004)
Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: an analysis of surgical morbidity and mortality.
B. Burt (2014)
Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy.
S. Boeluekbas (2011)
Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985.
K. Antman (1988)
Does Surgery Improve Survival of Patients with Malignant Pleural Mesothelioma?: A Multicenter Retrospective Analysis of 1365 Consecutive Patients
P. Bovolato (2014)
This paper is referenced by
Malignant pleural mesothelioma: beyond the mathematical models
G. Leuzzi (2016)
The South West Area Mesothelioma and Pemetrexed trial: a multicentre prospective observational study evaluating novel markers of chemotherapy response and prognostication
C. Hooper (2015)
Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
M. Carbone (2019)
Systemic inflammation in malignant pleural mesothelioma: Is neutrophyl-to-lymphocyte ratio a prognostic index?
Felice Mucilli (2016)
Clinical staging of malignant pleural mesothelioma: current perspectives
M. Bonomi (2017)
Management of Malignant Pleural Mesothelioma in the Elderly Population
V. Verma (2019)
ERS/EACTS statement on the management of malignant pleural effusions
A. Bibby (2018)
Calretinin but not caveolin-1 correlates with tumour histology and survival in malignant mesothelioma.
B. Thapa (2016)
ENVIRONMENTAL AND OCCUPATIONAL RISK FACTORS AND PREDICTORS OF SURVIVAL AMONG MALIGNANT PLEURAL MESOTHELIOMA PATIENTS
A. Abdel-HamidM (2019)
Patterns of care and survival of older patients with malignant pleural mesothelioma.
Anthony Linton (2019)
Ambulatory treatment in the management of pneumothorax: a systematic review of the literature
F. Brims (2013)
Posttranscriptional Regulation Controls Calretinin Expression in Malignant Pleural Mesothelioma
Jelena Kresoja-Rakic (2017)
Novel systemic therapy against malignant pleural mesothelioma.
M. R. Mancuso (2017)
Prognostic factors and treatment outcomes of malignant pleural mesothelioma in Eastern Asian patients - A Taiwanese study.
Ting-Hui Wu (2019)
Identification of cis- and trans-acting elements regulating calretinin expression in mesothelioma cells
Jelena Kresoja-Rakic (2016)
Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends
M. Soeberg (2016)
Advances in treatment of mesothelioma
C. Maggioni (2016)
Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort
W. Amin (2018)
Malignant pleural mesothelioma.
D. Ettinger (2012)
Extended Tumor Control after Dendritic Cell Vaccination with Low-Dose Cyclophosphamide as Adjuvant Treatment in Patients with Malignant Pleural Mesothelioma.
R. Cornelissen (2016)
Advances in the diagnosis, treatment and prognosis of malignant pleural mesothelioma.
Weiquan Zhang (2015)
Characteristics and long‐term outcomes of advanced pleural mesothelioma in Latin America (MeSO‐CLICaP)
L. Rojas (2019)
MALIGN PLEVRAL MEZOTELYOMA AYIRICI TANISI VE PROGNOZUNDA 18F-FDG PET/BT’NİN ROLÜ
D. Şimşek (2019)
The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis
R. Dolan (2017)
The epithelioid BAP1‐negative and p16‐positive phenotype predicts prolonged survival in pleural mesothelioma
A. Chou (2018)
Tumor-Derived GM-CSF Promotes Granulocyte Immunosuppression in Mesothelioma Patients
Swati Khanna (2018)
Caring for Patients with Mesothelioma: Principles and Guidelines
M. Hesdorffer (2019)
Pilot and Feasibility Trial Evaluating Immuno-Gene Therapy of Malignant Mesothelioma Using Intrapleural Delivery of Adenovirus-IFNα Combined with Chemotherapy
D. Sterman (2016)
Transcriptomic Analysis of the Claudin Interactome in Malignant Pleural Mesothelioma: Evaluation of the Effect of Disease Phenotype, Asbestos Exposure, and CDKN2A Deletion Status
E. Rouka (2017)
Human mesothelioma induces defects in dendritic cell numbers and antigen-processing function which predict survival outcomes
S. Cornwall (2016)
Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma
M. Mencoboni (2017)
Pretreatment thrombocytosis as a significant prognostic factor in malignant mesothelioma: a meta-analysis
Y. Zhuo (2017)See more