Contemporary Analysis of Prognostic Factors in Patients with Unresectable Malignant Pleural Mesothelioma

Abstract

Introduction Previous prognostic scoring systems for MPM included patients managed surgically and predated the use of pemetrexed. We analyzed prognostic factors in a contemporary cohort of patients with unresectable MPM who received pemetrexed-based chemotherapy. Methods This single institution analysis included MPM patients managed non-surgically from 2000–2013. Variables correlated with overall survival (OS) included sex, performance status (PS), asbestos exposure, tumor laterality, histology, clinical stage, initial PET maximum Standardized Uptake Value (SUVmax), hemoglobin, platelet, lymphocyte, white cell (WBC) and neutrophil counts, treatment type, and clinical benefit from treatment. OS was analyzed by Kaplan-Meier method, and significance (p<0.05) of prognostic factors was analyzed by log-rank test and Cox regression. Results 191 patients met study criteria: median age 71 years (range 46–90), 147 (77%) male, 128 (67%) epithelioid tumors, 157 (82%) stage III-IV. Median OS for all patients was 13.4 months. By univariate analysis, histology (p<0.001), platelet count (≤450,000 vs >450,000 p<0.001), initial PS (0–1 versus ≥ 2), SUVmax (> or ≤8.1, p=0.037), and lymphocyte counts (p=0.019) were associated with OS. By multivariable analysis, only histology, platelet count and PS were independent prognostic factors. Epithelioid histology, PS and elevated lymphocyte count at diagnosis were significantly associated with clinical benefit from first-line chemotherapy. Conclusions Our results confirm the significance of elements of the CALGB and EORTC prognostic scoring systems, identify factors associated with clinical benefit from chemotherapy, and emphasize the impact of histology and clinical benefit of chemotherapy on outcomes.

Prognostic Impact of Inflammation-related Biomarkers on Overall Survival of Patients with Inoperable Malignant Pleural Mesothelioma

“…This means that in the present study it was possible to prevent overoptimistic estimates of test performance and externally validate the prognostic utility of CAR. In this study, neither stage nor PS were a significant prognostic factor of OS, while a recent report regarding the prognostic factors in 191 patients with unresectable MPM showed that PS, but not stage, was an independent prognostic factor (25). Another previous study that included 274 patients with MPM also showed that PS, but not stage, was an independent prognostic factor (1).…”

Clinicopathological and Survival Characteristics of Malignant Pleural Mesothelioma: A Single-Institutional Experience

“…[17] In a number of studies, mean survival has been reported to be 4-12 months in patients with nonepithelial histology. [15][16][17][18][19] The present study included 35 patients with epithelial histology and overall survival (p=0.682) and disease-free survival (p=0.617) were numerically higher, but not statistically significant, in comparison to patient groups with other histological types.…”

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

“…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. PD-L1 is an inhibitory ligand, which binds to the program-cell death-1 transmembrane protein expressed on T cells, B cells and NK cells.…”