Prognostic Factors for Mesothelioma
Section snippets
Clinical prognostic factor scoring systems
The best known published prognostic scoring systems are those of the European Organization for the Research and Treatment of Cancer (EORTC) [12] and the Cancer and Leukemia Group B (CALGB) in the United States [13]. These systems show that the most important predictors of poor prognosis in pleural mesothelioma are poor performance status, non-epithelioid histology, male gender, low hemoglobin, high platelet count, high white blood cell count, and high lactate dehydrogenase level. These systems
University of Leicester Hospitals, Leicester, England
In 2000, Edwards and colleagues [14] of Leicester, England, published a retrospective analysis of a series of 142 patients who had mesothelioma. Some of these patients had surgical intervention, whereas others were treated with chemotherapy or supportive care alone. Univariate analysis of prognostic variables was performed using a Cox proportional hazards regression model. Statistically significant variables were analyzed further in a stepwise multivariate model. The authors then derived EORTC
Molecular prognostic markers in malignant mesothelioma
In the last 3 years, pivotal research has been published on the molecular genetic profile of malignant mesothelioma. Data acquired by genomics technology should produce fundamental insights into all aspects of the tumor's biology. Prognostication and treatment will improve when the key genetic events in mesothelioma initiation and propagation are understood. Mesothelioma has an unusual molecular biology, with loss of tumor suppressor genes being especially significant. The P16INK4A, P14ARF, and
Predictors of survival in patients treated surgically
A brief review of the surgical prognostic predictors is included from the two largest series available. From 1980 to 1997, 183 patients underwent EPP followed by adjuvant chemotherapy and radiotherapy (various protocols were used) at Brigham and Women's Hospital in Boston [4], [6]. There were seven (3.8%) acute deaths, and a morbidity rate of 50% was quoted. The 2-year survival rate was 38% in the 176 remaining patients. The 5-year survival rate was 15% and the median overall survival was 19
Other prognostic predictors for mesothelioma
PET is established as an important staging modality in many cancers, and PET standard update value (SUV) is reported as a prognostic indicator in several malignancies. The role of PET in prognostication of mesothelioma is unclear, however. From 1998 to 2003, 65 patients who had pleural mesothelioma at Memorial Sloan-Kettering Cancer Center underwent PET scans [29]. Median PET SUV in the primary tumor was 6.6 (range, 2–23), and the median follow-up for all surviving patients was 16 months.
Summary
Knowledge of the clinical behavior, treatment, and molecular biology of malignant mesothelioma is accumulating rapidly. The disease is no longer considered an untreatable rarity but rather is an interesting disease of known origin (in most cases) that will provide crucial insights into cancer biology. Treatment is improving, with palliative two-drug chemotherapy being an established approach for fitter patients. A small proportion of patients are candidates for radical surgery, although
Acknowledgments
The author thanks the following persons for their assistance in providing data for this article: Raja Flores, MD (New York, NY) and Dean Fennell, MD, PhD (Belfast, Northern Ireland).
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Cited by (28)
Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): A randomised, controlled, open-label, phase 3 trial
2016, The LancetCitation Excerpt :Malignant pleural mesothelioma is a rare but aggressive cancer, mainly caused by exposure to asbestos.1 The disease has a poor prognosis, with sarcomatoid or mixed (sarcomatoid and epithelioid) histologies, Eastern Cooperative Oncology Group (ECOG) performance status of 1 or higher, and male sex usually reported as poor prognostic factors.2 It is generally refractory to local treatment when diagnosed and usually progresses, resulting in a median overall survival (OS) of 12–36 months for localised disease and 8–14 months for advanced disease.3
A novel clinical prediction model for prognosis in malignant pleural mesothelioma using decision tree analysis
2016, Journal of Thoracic OncologyCitation Excerpt :This may in turn inform treatment decisions, such as identifying those who may be candidates for clinical trials when most likely to benefit from systemic or local anticancer therapy or identifying those for whom early palliation may be more appropriate. To date, the largest, best validated models have been developed on the basis of populations within chemotherapy clinical trials4–7; other reports utilize variables that are limited by the use of specific tests (e.g., immunohistochemical, imaging, or genetic approaches) that are not widely available, again limiting their utility in the general population.1 Consequently, although models derived from clinical trial populations are sometimes used as stratification factors in randomized studies, these are not necessarily valid in unselected populations at presentation, and currently, prognostic models are not widely utilized for MPM patients in routine clinical practice.
Expression profiling stratifies mesothelioma tumors and signifies deregulation of spindle checkpoint pathway andmicrotubule network with therapeutic implications
2014, Annals of OncologyCitation Excerpt :Malignant pleural mesothelioma (MPM) is an ill-understood aggressive malignant growth of the pleura surrounding the lungs with affected patients showing low median overall survival and poor response to most treatment regimens [1]. Histologically, there are three subtypes of MPM: epitheloid, sarcomatoid and biphasic or mixed, and MPM patients with sarcomatoid subtype show worse survival after surgery while those with epitheloid subtype show the best overall survival [2]. However, in all tumor stages, even with the best available chemotherapeutic treatment, the increase in median survival of MPM patient's is marginal [3].
Importance of gender in diffuse malignant peritoneal mesothelioma
2012, Annals of OncologyCitation Excerpt :The incidence of DMPM is significantly higher in men, possibly related to their increased occupational exposure to asbestos [4, 9]. Female gender has been previously reported as a favorable prognostic factor [10–12]. However, this finding has been inconsistent, possibly due to the limited number of patients recruited for each individual study [11, 13–15].
Sustained expression of steroid receptor coactivator SRC-2/TIF-2 is associated with better prognosis in malignant pleural mesothelioma
2012, Journal of Thoracic OncologyOutcomes with first-line platinum-based combination chemotherapy for malignant pleural mesothelioma: A review of practice in British Columbia
2009, Lung CancerCitation Excerpt :In addition, among those treated with first-line gemcitabine only two received pemetrexed as salvage therapy, either alone or in combination with a platinum analog, and survival in that group is not attributable to a crossover effect. Prognostic factors identified in this cohort are similar to what has been reported in the literature [20]. The assessment of stage based on data available on chart review may account for the lack of prognostic value for the IMIG stage in this cohort.