Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis

Baud, M.; Strano, Salvatore; Dechartres, Agnès; Jouni, Rami; Triponez, Frédéric; Chouaïd, C.; Forgez, Patricia; Damotte, Diane; Roche, N.; Régnard, Jean-François; Alifano, Marco

doi:10.1016/j.jtcvs.2012.09.023

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…Extra‐pleural pneumonectomy preceded by neoadjuvant chemotherapy and followed by hemithorax irradiation has almost been abandoned in routine practice in France . Treatment of advanced MPMs relies primarily on chemotherapy with combination platinum and pemetrexed and, more recently, bevacizumab .…”

Section: Introductionmentioning

confidence: 99%

Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

Chouaïd

Andujar

Blein³

et al. 2018

Cancer Medicine

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This study was undertaken to determine the healthcare burden of malignant pleural mesothelioma (MPM) in France and to analyze its associations with socioeconomic deprivation, population density, and management outcomes. A national hospital database was used to extract incident MPM patients in years 2011 and 2012. Cox models were used to analyze 1‐ and 2‐year survival according to sex, age, co‐morbidities, management, population‐density index, and social deprivation index. The analysis included 1,890 patients (76% men; age: 73.6 ± 10.0 years; 84% with significant co‐morbidities; 57% living in urban zones; 53% in highly underprivileged areas). Only 1% underwent curative surgical procedure; 65% received at least one chemotherapy cycle, 72% of them with at least one pemetrexed and/or bevacizumab administration. One‐ and 2‐year survival rates were 64% and 48%, respectively. Median survival was 14.9 (95% CI: 13.7–15.7) months. The mean cost per patient was 27,624 ± 17,263 euros (31% representing pemetrexed and bevacizumab costs). Multivariate analyses retained men, age >70 years, chronic renal failure, chronic respiratory failure, and never receiving pemetrexed as factors of poor prognosis. After adjusting the analysis to age, sex, and co‐morbidities, living in rural/semi‐rural area was associated with better 2‐year survival (HR: 0.83 [95% CI: 0.73–0.94]; P < 0.01); social deprivation index was not significantly associated with survival. With approximately 1,000 new cases per year in France, MPMs represents a significant national health care burden. Co‐morbidities, sex, age, and living place appear to be significant factors of prognosis.

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Section: Introductionmentioning

confidence: 99%

Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

Chouaïd

Andujar

Blein³

et al. 2018

Cancer Medicine

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“…23,24 Currently, risk factors used for predicting outcomes after surgery for MPM are histologic subtype, lymph node status, resection margin status, and stage. 8,25 However, these factors cannot be determined before major surgery, making them irrelevant to the decision to undergo resection. Therefore, the identification of preoperative prognostic factors is crucial for allowing patients to make informed decisions regarding treatment, and for classifying patients into groups with distinctly different outcomes to evaluate novel therapeutic approaches.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Gene Expression Test for Mesothelioma Prognosis in Formalin-Fixed Paraffin-Embedded Tissues

Rienzo

Cook²,

Wilkinson

et al. 2017

The Journal of Molecular Diagnostics

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A molecular test performed using fresh-frozen tissue was proposed for use in the prognosis of patients with pleural mesothelioma. The accuracy of the test and its properties was assessed under Clinical Laboratory Improvement Amendmentseapproved guidelines using FFPE tissue from an independent multicenter patient cohort. Concordance studies were performed using matched frozen and FFPE mesothelioma samples. The prognostic value of the test was evaluated in an independent validation cohort of 73 mesothelioma patients who underwent surgical resection. FFPE-based classification demonstrated overall high concordance (83%) with the matched frozen specimens, on removal of cases with low confidence scores, showing sensitivity and specificity in predicting type B classification (poor outcome) of 43% and 98%, respectively. Concordance between research and clinical methods increased to 87% on removal of low confidence cases. Median survival times in the validation cohort were 18 and 7 months in type A and type B cases, respectively (P Z 0.002). Multivariate classification adding pathologic staging information to the gene expression score resulted in significant stratification of risk groups. The median survival times were 52 and 14 months in the low-risk (class 1) and intermediate-risk (class 2) groups, respectively. The prognostic molecular test for mesothelioma can be performed on FFPE tissues to predict survival, and can provide an orthogonal tool, in combination with established pathologic parameters, for risk evaluation.

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“…Multiple observational studies have reported prognostic factors in mesothelioma, although many were susceptible to selection bias, having been undertaken in selected populations [164][165][166][167][168][169][170][171]. The forthcoming ERS task force statement on mesothelioma contains information on prognostication, and therefore a full summary of the literature is not replicated here.…”

Section: Prognostication In Mesotheliomamentioning

confidence: 99%

“…In brief, certain factors are consistently associated with survival in mesothelioma, i.e. sex, age, epithelioid differentiation, PS and tumour stage [117,157,[164][165][166][167][168][169][170][172][173][174][175][176][177][178][179][180][181]. However, for other factors, including presenting symptoms or quantification of asbestos exposure, the relationship with survival is less clear [163,165,168,173,[182][183][184].…”

Section: Prognostication In Mesotheliomamentioning

confidence: 99%

“…sex, age, epithelioid differentiation, PS and tumour stage [117,157,[164][165][166][167][168][169][170][172][173][174][175][176][177][178][179][180][181]. However, for other factors, including presenting symptoms or quantification of asbestos exposure, the relationship with survival is less clear [163,165,168,173,[182][183][184]. Multiple inflammatory markers correlate with survival, including white cell count [121,145,157,162,166,[168][169][170], platelet count [157,164,166,169,170,172,177], C-reactive protein [157,164,166,169,170,172,…”

Section: Prognostication In Mesotheliomamentioning

confidence: 99%

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ERS/EACTS statement on the management of malignant pleural effusions

et al. 2018

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Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

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Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis

Abstract: Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival.

Cited by 21 publications

References 28 publications

Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

Validation of a Gene Expression Test for Mesothelioma Prognosis in Formalin-Fixed Paraffin-Embedded Tissues

ERS/EACTS statement on the management of malignant pleural effusions

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