Malignant Mesothelioma, Hypoalbuminaemia and the Effect of Carboplatin/Pemetrexed on Survival

Murphy, Stephen; Probert, Gemma; Anderson, Joanne; Pollock, Susan E.; Taylor, Ian; Clague, H. W.; Sridharan, K.

doi:10.1016/j.clon.2013.08.009

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Analyses of pooled clinical trial data have demonstrated the prognostic impact of certain demographic variables (age and gender), clinical and pathological data (haemoglobin levels, leukocyte and platelet counts and performance status) and tumour characteristics (histological subtype) leading to the development of two scoring systems, one developed by the European Organisation for Research and Treatment of Cancer (EORTC) and the other by the Cancer and Leukaemia Group B (CALGB) ( Curran et al , 1998 ; Herndon et al , 1998 ; Fennell et al , 2005 ; Meniawy et al , 2013 ). However, these systems do not include more recently identified prognostic factors, such as clinical stage at diagnosis ( Abakay et al , 2013 ), hypo-albuminaemia ( Murphy et al , 2013 ) and the neutrophil–lymphocyte ratio (NLR) ( Kao et al , 2010 ; Kao et al , 2011 ). Non-randomised studies in MPM patients who received radical surgery revealed that clinical stage, histological subtype and the use of pemetrexed-based chemotherapy were associated with longer-term survival ( Flores et al , 2008 ; Yan et al , 2011 ).…”

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confidence: 99%

Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales

et al. 2014

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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.

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confidence: 99%

Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales

et al. 2014

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“…Serum albumin level is a simple and objective indicator to evaluate malnutrition. Multiple studies have demonstrated hypoalbuminemia as an adverse independent prognostic factor for mesothelioma [19,20,67].…”

Section: Clinical Factorsmentioning

confidence: 99%

Predictive and Prognosis Factors of Clinical Utility in Mesothelioma

Rafael¹,

Rafael²

2020

Mesothelioma

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The constant research in therapeutics for mesothelioma has been improving their tumor response and overall survival, generating the need to propose markers that guide the doctor's therapeutic approach in a more precise way. Recently, different predictive factors have been proposed, such as mesothelin-related peptides, fibulin-3, and osteopontin associated with an image giving information about the probability of tumor response to a therapeutic agent or a combination of agents. As is well known, the importance of prognostic markers of utility lies in providing prospective information on the evolution of the patient and thus their ability to guide therapeutic decisions. Although the clinical stage and histology are currently the most described prognostic factors, recent studies have shown interest in the expression of estrogen receptor beta and calretinin, among other promising factors. Given the heterogeneity of this broad field of research in mesothelioma, it is necessary to objectively present the prognostic and predictive factors of greater clinical utility.

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“…The negative impact of poor PS, older age, male sex, and laboratory parameters included in the CALGB and EORTC models, such as high platelets and WBC count, have been confirmed as well. Other parameters like neutrophil:lymphocyte ratio, 18 , 19 albumin, 24 lymphocyte:monocyte ratio, and other inflammatory markers, such as CRP levels 21 , 28 , 30 or comorbidities, 25 have been investigated, but none has been included in everyday clinical practice so far. More recently, the expression of B7H1 (PDL1) has been related to nonepithelioid histology and worse overall survival (OS) in several series of MPM; 31 – 33 however, its potential role as a surrogate marker of response to immunotherapy with immune-checkpoint inhibitors is still debated.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Clinical staging of malignant pleural mesothelioma: current perspectives

Bonomi¹,

Filippis²,

Lopci

et al. 2017

LCTT

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Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.

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Malignant Mesothelioma, Hypoalbuminaemia and the Effect of Carboplatin/Pemetrexed on Survival

Cited by 6 publications

References 22 publications

Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales

Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales

Predictive and Prognosis Factors of Clinical Utility in Mesothelioma

Clinical staging of malignant pleural mesothelioma: current perspectives

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