Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting

Abstract

Background: This study aims to investigate patient-and disease characteristics associated with survival in malignant pleural mesothelioma (MPM) patients with anti-tumor treatment or with best supportive care (BSC). Materials and methods: Consecutive MPM cases diagnosed in North Denmark Region from 1972 to 2015 were reevaluated and verified by two pathologists using modern immunohistochemical techniques. Danish registries and hospital records were used to gather patient-, asbestos exposure-, and disease information. Results: Of the 279 patients, anti-tumor treatment was administered to 184 patients (66.0%). All of those received chemotherapy alone or as part of a multimodal treatment, where pemetrexed was given to 126 (68.5%) patients. Asbestos exposure was documented in 92.5% of all patients. In the treated group, mean age was lower (66 years versus 74 years, p < 0.01), rate of occupational asbestos exposure was higher (74.5 versus 54.7%, p < 0.01), more patients had better performance score (98.4 versus 60%, p < 0.01) and stage was lower (81 versus 63.2%, p < 0.01) compared to the BSC group. Multivariate analysis showed that epithelioid subtype was the only common prognostic factor for OS in both groups. In BSC patients, good PS and female gender was associated with improved OS. Median overall survival (OS) was 17 versus 4 months (p < 0.01), and independently of the histopathological subtype, the median and 2-year survival was higher in the treated versus the BSC group (p < 0.02). Conclusions: This retrospective study showed that epithelioid subtype is the only independent positive prognostic factor of survival in treated patients with MPM. For BSC patients, the epithelioid subtype, good PS, and female gender were positive prognostic factors, while age and comorbidities were not significant. This study with long-term follow-up of treated and BSC MPM patients can contribute to the clinical stratification of patients. Further validation is appropriate to verify these findings.

Intratumor microbiota as a novel potential prognostic indicator in mesothelioma

“…Finally, it should be noted that a retrospective study revealed that adjuvant treatment with gemcitabine improves survival in K. pneumoniae-negative pancreatic cancer patients, whereas adjuvant treatment with quinolones (which are bactericidal) was associated with better overall survival (OS). This result suggests that the presence of K. pneumoniae may promote chemoresistance to adjuvant gemcitabine in pancreatic cancer (45). Taken together, is evident that the wider literature supports the negative impact Klebsiella has on patients, which is consistent with our finding that Klebsiella was more abundant in Low Survivors than High Survivors.…”

“…Further to the above, the identification that epithelioid histology was a significant prognostic indicator compared to other variables has evidence in the literature ( 46 ). As Petersen and colleagues published in 2021, epithelioid histology was the only positive independent prognostic factor for treated pleural mesothelioma patients ( 46 ). In this patient cohort, neither age nor gender nor stage were significant by univariate analysis for overall survival (OS).…”

“…In this patient cohort, neither age nor gender nor stage were significant by univariate analysis for overall survival (OS). It should be noted that another group in the same study ( 46 ), those receiving best supportive care (BSC) rather than anti-tumor treatment, did demonstrate, via univariate analysis, significant association for gender (female), epithelioid histology, and performance status. However, stage was significant for the BSC group only at the p<0.1 level, not p<0.05 level, thus indicating general agreement between the results by Petersen ( 46 ) and the results presented in this article.…”

Prognostic significance of inflammation-related and electrolyte laboratory variables in patients with malignant pleural mesothelioma

“…As a result, their prognosis may be better, consistent with a previous study ( 34 , 35 ). However, whether age affect the prognosis of patients is still controversial ( 36 , 37 ). This result should be validated in subsequent large-sample studies.…”

Living with mesothelioma: A systematic review of patient and caregiver psychosocial support needs

“…Although survival following diagnosis is relatively short, 10 a small number of long survivors have been reported. 10,69,70 A few prognostic scoring systems have been proposed to predict survival in mesothelioma patients [71][72][73] but these remain suboptimal.…”