Survival analysis via nomogram of surgical patients with malignant pleural mesothelioma in the Surveillance, Epidemiology, and End Results database

Abstract

Background Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor that originates from the pleura and has a poor prognosis. Eligible patients can benefit from surgery, but their survival is affected by many factors. Therefore, we created a graphic model that could predict the prognosis of surgically treated patients. Methods We retrospectively analyzed data from the Surveillance, Epidemiology, and End Results database from 2004 to 2014 to identify the key factors affecting the prognosis of surgically treated MPM patients. On this basis we built a nomogram to predict survival. We then evaluated the performance of the nomogram in a validation cohort. Results In a training cohort of 828 cases, independent prognostic factors, including age, gender, histological type, differentiation, N stage, chemotherapy, type of surgery, and lymph node dissection, were identified. We then developed a nomogram to evaluate individual patient survival. In Kaplan–Meier analysis, a higher score in the nomogram was associated with a worse prognosis. We also used a validation cohort consisting of 312 patients to evaluate the performance of the nomogram, which was well calibrated and had good discrimination ability, with concordance indices of 0.715 and 0.656 for the training and validation cohorts, respectively. Conclusion This study has improved our understanding of resected MPM and shown that key factors, including age and histological type, are associated with overall survival. The nomogram is a reliable tool that can help clinicians turn individualized prediction into reality and maximize patient benefit by identifying the most beneficial treatment approach.

Analysis of the Trends in Publications on Clinical Cancer Research in Mainland China from the Surveillance, Epidemiology, and End Results (SEER) Database: Bibliometric Study

“…The latest NCCN and ESMO guidelines cited several publications on rare cancers based on SEER data, such as male breast cancer, occult breast cancer, and mesenchymal chondrosarcoma [28][29][30]. Thus, these publications based on SEER data provided insight to help clarify the characteristics, treatment protocols, prognostic indicators, and risk stratification of rare cancers [31,32].…”

Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma

“…[21][22][23][24] With changing demographics, age is currently a less stringent exclusion criterion for surgery; however, in the literature the age limit for favorable outcome varies from younger than 45 years 25 to younger than 70 years 6 (overall survival [OS] 19.8 vs 11.7 months; P<.001, multivariate analysis) 26 as an independent prognostic factor, and surgery was associated with improved survival in patients aged !70 years but not in those aged !80 years in a Cox proportional hazards survival model published by Yang and colleagues. 23 Consistent with these results, the Beijing group of Zhuo and colleagues 27 used the recent SEER (Surveillance, Epidemiology, and End Results) database to produce a nomogram showing that the mortality risk increases strongly with increasing age in patients older than 70 years. Thus, surgery on patients older than 70 years must be very carefully decided upon because it may not translate into a survival benefit.…”

“…Thus, surgery on patients older than 70 years must be very carefully decided upon because it may not translate into a survival benefit. 27 Another prognosticator of outcome and survival after surgery for MPM is gender. Female gender was associated with improved survival 21,28 (OS 12.0 vs 9.9 months, P<.001; 29 25 ) was independently associated with reduced OS (all P < .05).…”

“…Female gender was associated with improved survival 21,28 (OS 12.0 vs 9.9 months, P<.001; 29 25 ) was independently associated with reduced OS (all P < .05). 27 Circulating estrogen, present in young but not older women, and the expression of the estrogen receptor b, have been suggested to play a role in the survival difference between genders. 30,31 In one of the first studies by Curran and colleagues 10 the combination of poor performance status Eastern Cooperative Oncology Group (ECOG) status 1 or 2, high white blood cell (WBC) count (>8.3 Â 10 9 /L), and male gender were in general associated with poor prognosis, 32,33 whereas ECOG status 0 (27.4 vs 9.7 months; P 5 .015) was a preoperative factor predicting benefit for surgery and survival.…”

Impact of metallothionein-knockdown on cisplatin resistance in malignant pleural mesothelioma

“…The state-of-the-art systemic treatment of unresectable and advanced MPM is chemotherapy including a combination of cis- or carboplatin and the antifolate pemetrexed 3 , 4 . However, MPM patients have poor prognosis with a median survival of approximately 14 months 5 . The response rate of MPM to single-agent cisplatin-based antiproliferative treatment is merely 14%, in the combination with pemetrexed response rates are up to 45% 6 .…”