A Novel Clinical Prediction Model for Prognosis in Malignant Pleural Mesothelioma Using Decision Tree Analysis

Brims, Fraser; Meniawy, Tarek; Duffus, Ian; Fonseka, Duneesha de; Segal, Amanda; Creaney, Jenette; Maskell, Nicholas; Lake, Richard; Klerk, Nicholas de; Nowak, Anna K.

doi:10.1016/j.jtho.2015.12.108

Cited by 130 publications

(118 citation statements)

References 33 publications

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“…The following scores are described in more detail below; the EORTC prognostic score (EPS), the CALGB score, 82–87 mGPS have been studied retrospectively in a cohort of patients with mesothelioma, 71 the LENT prognostic score 88 and a prognostic model using decision tree analysis was published by Brims et al 89 in 2016.…”

Section: Section 8: Factors Determining Prognosis and Timing Of Treatmentioning

confidence: 99%

“…Brims et al derived a prognostic model using classification and regression tree analysis from an unselected population of 482 patients newly diagnosed with MPM in Western Australia, of whom 274 were collected retrospectively and 208 prospectively 89 . Unlike the cohorts used to derive the CALGB and EORTC models, which were of participants in chemotherapy trials, this paper included all patients with a confirmed diagnosis of MPM within the inclusion period.…”

Section: Section 8: Factors Determining Prognosis and Timing Of Treatmentioning

confidence: 99%

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British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

Woolhouse

Bishop

Darlison

et al. 2018

Thorax

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Section: Section 8: Factors Determining Prognosis and Timing Of Treatmentioning

confidence: 99%

Section: Section 8: Factors Determining Prognosis and Timing Of Treatmentioning

confidence: 99%

British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

Woolhouse

Bishop

Darlison

et al. 2018

Thorax

Self Cite

170

219

View full text Add to dashboard Cite

“…Our data also included a higher proportion of patients not having chemotherapy (53% did not), and this differs to other previously published datasets. 4 This may be due to inclusion of patients from 2006, three years prior to pharmaceutical benefit schedule (PBS) approval to subsidize pemetrexed in the treatment of MPM. In the cohort of patients prior to this event, the majority of patients were aged older than 75, and this may explain why there was a higher rate of patients receiving best supportive care.…”

Section: F I G U R E 2 Examples Of Pd-l1 Staining In Tumor Tissuesmentioning

confidence: 99%

“…Older age, male gender and sarcomatoid histological subtypes have been shown to correlate with poor survival. 4 Epithelioid subtype has a median survival of 14.8 months, not classified subtype, 13.9 months, biphasic subtype 9.1 months, and 4 Clinical variable such as weight loss, anemia, hypoalbuminemia and platelet count are also other poor prognostic factors. 5 Expression of programmed death ligand 1 (PD-L1) has been studied in several tumors as a prognostic biomarker.…”

Section: Introductionmentioning

confidence: 99%

PD‐L1 expression associated with worse survival outcome in malignant pleural mesothelioma

Nguyen

Montgomery

Fadia

et al. 2017

Asia-Pac J Clncl Oncology

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Aim: There is currently a need to identify prognostic biomarkers to assist in a risk adopted approach in treatment of malignant pleural mesothelioma (MPM). Expression of programmed death ligand 1 (PD-L1) has been studied as a prognostic biomarker in a number of tumors given its central role in antitumoral immune response evasion. Four previously published analyses found PD-L1 positivity to be an adverse survival prognostic factor in MPM. This study aims to further investigate the relationship between PD-L1 expression in mesothelioma tissues and survival outcome.Methods: Clinical data of MPM patients from a single institution between 2006 and 2016 were reviewed. Patient's archived tissues were stained with PD-L1 (Clone Ventana SP263). PD-L1 positivity was defined as > 1% membranous staining regardless of intensity.Results: Data from fifty eight patients were analyzed. Median age was 73, majority was male (49, 84%) and had ECOG between 0 and 2 (46, 79%). Most common histopathological subtype was epithelioid (42, 72%), 9 (16%) biphasic subtype and 7 (12%) sarcomatoid. Thirty one patients (53%) received best supportive care and twenty seven patients (47%) received chemotherapy or combination treatment. Forty-two patients had positive PD-L1 expression (72.4%). The median survival time for PD-L1 negative group is 15.5 months and 6 months for the positive group. Positive PD-L1 expression is independently correlated with worse prognosis (HR = 2.02; 95% CI, 1.005-4.057; P-value = 0.0484).Conclusions: Our analysis found a higher percentage of MPM patients with positive PD-L1 (> 1%) compared to other studies. Highly positive PD-L1 expression was associated with statistically significantly lower median survival time.

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“…It occurs most frequently in the pleura but may affect the peritoneum 1 2. Patients with mesothelioma have a high burden of symptoms,3 4 and median survival is less than 1 year 5. The UK and Australia have some of the highest death rates in the world from mesothelioma 6 7.…”

Section: Introductionmentioning

confidence: 99%

Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial

Brims

Gunatilake

Lawrie

et al. 2019

Thorax

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PurposeMalignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.MethodsWe performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.ResultsBetween April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.ConclusionThere is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.Trial registration number ISRCTN18955704.

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A Novel Clinical Prediction Model for Prognosis in Malignant Pleural Mesothelioma Using Decision Tree Analysis

Abstract: We have developed and validated a simple, clinically relevant model to reliably discriminate patients at high and lower risk of death using routinely available variables from the time of diagnosis in unselected populations of patients with MPM.

Cited by 130 publications

References 33 publications

British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

PD‐L1 expression associated with worse survival outcome in malignant pleural mesothelioma

Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial

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