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Br J Cancer. 2014 Oct 28;111(9):1860-9. doi: 10.1038/bjc.2014.478. Epub 2014 Sep 4.

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

Author information

1
1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Concord Cancer Centre, Sydney, Concord, NSW 2139, Australia [3] Sydney Medical School, University of Sydney, Sydney, Australia.
2
1] Sydney Medical School, University of Sydney, Sydney, Australia [2] Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
3
1] NHMRC Clinical Trials Centre, Camperdown, NSW 2050, Australia [2] Sydney Cancer Centre, Camperdown, NSW 2050, Australia.
4
1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia [3] Cancer Institute NSW, Alexandria, Sydney, NSW 1435, Australia.
5
1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia.
6
1] Concord Cancer Centre, Sydney, Concord, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia.

Abstract

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.

PMID:
25188323
PMCID:
PMC4453733
DOI:
10.1038/bjc.2014.478
[Indexed for MEDLINE]
Free PMC Article

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