Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population. Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyõgo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared. Results: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0% (n ¼ 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p < 0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center. Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival

Biomarkers for Malignant Pleural Mesothelioma—A Novel View on Inflammation

“…In a classification and regression tree analysis, Brims et al found the best survival for patients with no weight loss, a high hemoglobin level and a high serum albumin level [176]. Harris et al validated these findings for surgical patients undergoing cytoreductive surgery [175].…”

“…In addition, it was described to indicate short survival in different malignancies [168]. For MPM, hypoalbuminemia has been associated with poor survival for patients receiving different treatment modalities [102,103,114], but also selectively for chemotherapy patients [174] and surgical patients [175].…”

Prediction modeling using routine clinical parameters to stratify survival in malignant pleural mesothelioma patients complicated with malignant pleural effusion

“…This study demonstrated that the BRIMS score might be useful in prognosis risk stratification of patients, which was similar to a previous study. 19 The strongest predictive variable in the BRIMS score was weight loss, which is controversial. 20,21 In this study, the median time from the discovery of pleural effusion to the diagnosis of pleural mesothelioma was 60 days, and 81.2% of the patients were diagnosed using thoracoscopy, which reduced the time of diagnosis.…”

Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma

“…For example, the combination of weight loss with ECOG PS of 2 or more, or weight loss, ECOG PS 0-1 with sarcomatoid histology, conferred the worst median (interquartile range: IQR) survival of 7.4 (3.3 to 11.1) months, whereas the combination of no weight loss, normal haemoglobin and normal serum albumin was associated with the best survival with a median (IQR) 34.0 (22.9-47.0) months [76]. The model has been validated in different populations of MPM patients and may help stratify risk groups to inform different treatment options and discussions with patients and their families [115,116].…”