Additional Prognostic Variables Identified in Pleural Mesothelioma
Contact: Rob Mansheim
IASLC Director of Communications
DENVER – Refined models have been developed to better predict outcomes for patients with malignant pleural mesothelioma who are candidates for cytoreductive surgery. These prognostic models may provide a more accurate and minimally invasive method for predicting outcomes for patients who are surgical candidates, as well as determine patients who may benefit from chemotherapy.
Malignant pleural mesothelioma is a rare, but challenging disease, and the role of surgery is controversial, with a 4% operative mortality rate. The refined models are designed to help medical and surgical oncologists better select patients for cytoreduction. The models are possible because of the development of the first large, international database that includes more than 2,000 patients with staged malignant pleural mesothelioma diagnosed from 1995-2008. The initiative is the result of collaboration of the IASLC International Staging and Prognostic Factors Committee Mesothelioma Domain and the International Mesothelioma Interest Group.
The goal of the database was to examine CORE variables associated with survival after either palliative or potentially curative surgery for mesothelioma. CORE variables associated in multivariate analyses to be prognostically important included best stage, age, sex, histology (epithelioid or not), and the type of surgical procedure (palliative vs. extrapleural pneumonectomy or pleurectomy/decortication). The database represents the largest collection of surgically treated patients with mesothelioma for whom all of these CORE variables were recorded.
Several clinical factors were chosen for supplementary prognostic analyses, and documentation of all of these factors was available for 252 of the 2,141 patients in the database. On stepwise regression modelling, four of these factors were found to be prognostically relevant: use of adjuvant therapy, smoking history, white blood cell (WBC) count, and weight loss. Further analyses of data from as many patients as possible with the remainder of the supplementary variables and laboratory values (550 patients) demonstrated that adjuvant therapy, WBC count, and platelet count were prognostic indicators. A complete report on the analyses is published in the June issue of the Journal of Thoracic Oncology (JTO), the official journal of the IASLC.
“This is another example of how the IASLC has developed a huge registry for a thoracic malignancy, and data mining of the registry provides potentially useful information in patient selection for therapy,” says lead author Harvey I. Pass, MD, Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York. “It is hoped that the ongoing prospective registry will validate these initial data.” Dr. Pass is an IASLC member and a member of the Mesothelioma Domain of the IASLC Staging Committee.
Coauthors of the report include IASLC Staging Committee members Catherine Kennedy; Enrico Ruffini, MD; Hisao Asamura MD; John Edwards; Jan P. van Meerbeeck, MD, PhD; and Valerie W. Rusch, MD; as well as IASLC members David Rice, MB, BCh; Walter Weder, MD; and Hans Hoffmann.
About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer. Founded in 1974, the association’s membership includes more than 3,800 lung cancer specialists in 80 countries. To learn more about IASLC please visit www.iaslc.org.