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

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 . 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.

Synergistic anti-tumor effect of bullfrog sialic acid-binding lectin and pemetrexed in malignant mesothelioma

“…Previous studies have demonstrated that the epithelioid subtype is associated with more favorable survival outcomes compared to non-epithelioid subtypes [1, 37, 38]. We found that cSBL had strong cytotoxic effects in a broader range of mesothelioma cell types including pemetrexed- or cisplatin-resistant cells.…”

Contemporary Analysis of Prognostic Factors in Patients with Unresectable Malignant Pleural Mesothelioma

“…In our study, patients who had clinical benefit with first-line chemotherapy showed a 10 month improvement in median overall survival. Unlike a study by Kataoka et al 14 study, factors associated with a clinical benefit from chemotherapy were also evaluated in our study. Better PS, epithelioid histology and increased number of lymphocytes were associated with clinical benefit from first-line of chemotherapy.…”

Prognostic Impact of Inflammation-related Biomarkers on Overall Survival of Patients with Inoperable Malignant Pleural Mesothelioma

“…According to previous studies, histological type, stage, PS, and age were regarded as important confounding factors associated with OS (20,24), and they were considered in the analyses. Whether patients received platinum-based palliative chemotherapy in combination with pemetrexed was also considered in the analyses.…”

“…Of the 86 patients treated with palliative chemotherapy, 68 (79.1%) died during the follow-up period. According to a previous report, histological type, stage, PS, and age were considered in the multivariate analysis (20,24). Whether patients received platinum-based palliative chemotherapy in combination with pemetrexed was also considered.…”