Format

Send to

Choose Destination
Jpn J Clin Oncol. 2015 Jun;45(6):562-8. doi: 10.1093/jjco/hyv039. Epub 2015 Apr 2.

A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index.

Author information

1
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto Department of Respiratory Medicine, Hyogo Prefectural Amagasaki Hospital, Hyogo.
2
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto.
3
Cancer Center, Hyogo College of Medicine, Hyogo.
4
Department of Respiratory Medicine, Hyogo Prefectural Amagasaki Hospital, Hyogo.
5
Division of Respiratory Medicine, Hyogo College of Medicine, Hyogo.
6
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto Center for Innovative Research in Clinical Evaluative Science (CiRCLE), Fukushima Medical University, Hikarigaoka, Fukushima, Japan.
7
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto Center for Innovative Research in Clinical Evaluative Science (CiRCLE), Fukushima Medical University, Hikarigaoka, Fukushima, Japan fukuhara.shunichi.6m@kyoto-u.ac.jp.

Abstract

OBJECTIVE:

Existing prognostic indices for malignant pleural mesothelioma do not incorporate the recent advances in oncology care. The purpose of this study was to provide a prognostic index for overall survival in malignant pleural mesothelioma patients treated with chemotherapy with pemetrexed or best supportive care in the recent clinical setting.

METHODS:

A retrospective cohort study was performed in two hospitals in Japan (2007-13). The primary outcome was overall survival. The Cox proportional hazards model was used for multivariable analyses to identify prognostic factors. A final model was chosen based on both clinical and statistical significance.

RESULTS:

A total of 283 patients (chemotherapy: n = 228, best supportive care: n = 55) were enrolled in the study. On multivariate analysis, regimen including platinum plus pemetrexed, a performance status >0, non-epithelial histological type and Stage IV disease predicted poor overall survival in chemotherapy patients. As hazard ratios of individual risk factors were approximately similar, a prognostic index for overall survival was constructed by counting the risk factors. Median overall survival in chemotherapy patients decreased by each one-point increase in this count: 1030 days for zero; 658 days for one; 373 days for two; 327 days for three; 125 days for four. Internal validation using the bootstrapping technique showed robustness of the model (c-index, 0.677; 95% confidence interval, 0.624-0.729). Further, the discrimination was consistent in best supportive care patients (c-index, 0.799; 95% confidence interval, 0.725-0.874).

CONCLUSIONS:

This novel index can provide clinicians and malignant pleural mesothelioma patients with a better framework for discussing prognosis at the time of diagnosis.

KEYWORDS:

best supportive care; malignant pleural mesothelioma; palliative care; pemetrexed; prognostic index

PMID:
25838292
DOI:
10.1093/jjco/hyv039
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for Kyoto University Research Information Repository - Articles
Loading ...
Support Center