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. 2000 Sep;55(9):731–735. doi: 10.1136/thorax.55.9.731

Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems

J Edwards 1, K Abrams 1, J Leverment 1, T Spyt 1, D Waller 1, K O'Byrne 1
PMCID: PMC1745842  PMID: 10950889

Abstract

BACKGROUND—The incidence of malignant mesothelioma is increasing. There is the perception that survival is worse in the UK than in other countries. However, it is important to compare survival in different series based on accurate prognostic data. The European Organisation for Research and Treatment of Cancer (EORTC) and the Cancer and Leukaemia Group B (CALGB) have recently published prognostic scoring systems. We have assessed the prognostic variables, validated the EORTC and CALGB prognostic groups, and evaluated survival in a series of 142patients.
METHODS—Case notes of 142 consecutive patients presenting in Leicester since 1988 were reviewed. Univariate analysis of prognostic variables was performed using a Cox proportional hazards regression model. Statistically significant variables were analysed further in a forward, stepwise multivariate model. EORTC and CALGB prognostic groups were derived, Kaplan-Meier survival curves plotted, and survival rates were calculated from life tables.
RESULTS—Significant poor prognostic factors in univariate analysis included male sex, older age, weight loss, chest pain, poor performance status, low haemoglobin, leukocytosis, thrombocytosis, and non-epithelial cell type (p<0.05). The prognostic significance of cell type, haemoglobin, white cell count, performance status, and sex were retained in the multivariate model. Overall median survival was 5.9 (range 0-34.3) months. One and two year survival rates were 21.3% (95% CI 13.9 to 28.7) and 3.5% (0 to 8.5), respectively. Median, one, and two year survival data within prognostic groups in Leicester were equivalent to the EORTC and CALGB series. Survival curves were successfully stratified by the prognostic groups.
CONCLUSIONS—This study validates the EORTC and CALGB prognostic scoring systems which should be used both in the assessment of survival data of series in different countries and in the stratification of patients into randomised clinical studies.



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Selected References

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  1. Alberts A. S., Falkson G., Goedhals L., Vorobiof D. A., Van der Merwe C. A. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J Clin Oncol. 1988 Mar;6(3):527–535. doi: 10.1200/JCO.1988.6.3.527. [DOI] [PubMed] [Google Scholar]
  2. Antman K., Shemin R., Ryan L., Klegar K., Osteen R., Herman T., Lederman G., Corson J. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985. J Clin Oncol. 1988 Jan;6(1):147–153. doi: 10.1200/JCO.1988.6.1.147. [DOI] [PubMed] [Google Scholar]
  3. Boutin C., Rey F., Gouvernet J., Viallat J. R., Astoul P., Ledoray V. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 2: Prognosis and staging. Cancer. 1993 Jul 15;72(2):394–404. doi: 10.1002/1097-0142(19930715)72:2<394::aid-cncr2820720214>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  4. Chahinian A. P., Pajak T. F., Holland J. F., Norton L., Ambinder R. M., Mandel E. M. Diffuse malignant mesothelioma. Prospective evaluation of 69 patients. Ann Intern Med. 1982 Jun;96(6 Pt 1):746–755. doi: 10.7326/0003-4819-96-6-746. [DOI] [PubMed] [Google Scholar]
  5. Chailleux E., Dabouis G., Pioche D., de Lajartre M., de Lajartre A. Y., Rembeaux A., Germaud P. Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest. 1988 Jan;93(1):159–162. doi: 10.1378/chest.93.1.159. [DOI] [PubMed] [Google Scholar]
  6. Curran D., Sahmoud T., Therasse P., van Meerbeeck J., Postmus P. E., Giaccone G. Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience. J Clin Oncol. 1998 Jan;16(1):145–152. doi: 10.1200/JCO.1998.16.1.145. [DOI] [PubMed] [Google Scholar]
  7. De Pangher Manzini V., Brollo A., Franceschi S., De Matthaeis M., Talamini R., Bianchi C. Prognostic factors of malignant mesothelioma of the pleura. Cancer. 1993 Jul 15;72(2):410–417. doi: 10.1002/1097-0142(19930715)72:2<410::aid-cncr2820720216>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  8. Fusco V., Ardizzoni A., Merlo F., Cinquegrana A., Faravelli B., De Palma M., Chessa L., Nicolò G., Serra M., Capaccio A. Malignant pleural mesothelioma. Multivariate analysis of prognostic factors on 113 patients. Anticancer Res. 1993 May-Jun;13(3):683–689. [PubMed] [Google Scholar]
  9. Herndon J. E., Green M. R., Chahinian A. P., Corson J. M., Suzuki Y., Vogelzang N. J. Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest. 1998 Mar;113(3):723–731. doi: 10.1378/chest.113.3.723. [DOI] [PubMed] [Google Scholar]
  10. Kumar-Singh S., Jacobs W., Dhaene K., Weyn B., Bogers J., Weyler J., Van Marck E. Syndecan-1 expression in malignant mesothelioma: correlation with cell differentiation, WT1 expression, and clinical outcome. J Pathol. 1998 Nov;186(3):300–305. doi: 10.1002/(SICI)1096-9896(1998110)186:3<300::AID-PATH180>3.0.CO;2-Q. [DOI] [PubMed] [Google Scholar]
  11. Kumar-Singh S., Vermeulen P. B., Weyler J., Segers K., Weyn B., Van Daele A., Dirix L. Y., Van Oosterom A. T., Van Marck E. Evaluation of tumour angiogenesis as a prognostic marker in malignant mesothelioma. J Pathol. 1997 Jun;182(2):211–216. doi: 10.1002/(SICI)1096-9896(199706)182:2<211::AID-PATH834>3.0.CO;2-D. [DOI] [PubMed] [Google Scholar]
  12. McLean A. N., Patel K. R. Clinical features and epidemiology of malignant pleural mesothelioma in west Glasgow 1987-1992. Scott Med J. 1997 Apr;42(2):37–39. doi: 10.1177/003693309704200203. [DOI] [PubMed] [Google Scholar]
  13. Middleton G. W., Smith I. E., O'Brien M. E., Norton A., Hickish T., Priest K., Spencer L., Ashley S. Good symptom relief with palliative MVP (mitomycin-C, vinblastine and cisplatin) chemotherapy in malignant mesothelioma. Ann Oncol. 1998 Mar;9(3):269–273. doi: 10.1023/a:1008236010868. [DOI] [PubMed] [Google Scholar]
  14. Ohta Y., Shridhar V., Bright R. K., Kalemkerian G. P., Du W., Carbone M., Watanabe Y., Pass H. I. VEGF and VEGF type C play an important role in angiogenesis and lymphangiogenesis in human malignant mesothelioma tumours. Br J Cancer. 1999 Sep;81(1):54–61. doi: 10.1038/sj.bjc.6690650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pass H. I., Temeck B. K., Kranda K., Steinberg S. M., Feuerstein I. R. Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 1998 Feb;115(2):310–318. doi: 10.1016/S0022-5223(98)70274-0. [DOI] [PubMed] [Google Scholar]
  16. Peto J., Decarli A., La Vecchia C., Levi F., Negri E. The European mesothelioma epidemic. Br J Cancer. 1999 Feb;79(3-4):666–672. doi: 10.1038/sj.bjc.6690105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Peto J., Hodgson J. T., Matthews F. E., Jones J. R. Continuing increase in mesothelioma mortality in Britain. Lancet. 1995 Mar 4;345(8949):535–539. doi: 10.1016/s0140-6736(95)90462-x. [DOI] [PubMed] [Google Scholar]
  18. Ruffie P., Feld R., Minkin S., Cormier Y., Boutan-Laroze A., Ginsberg R., Ayoub J., Shepherd F. A., Evans W. K., Figueredo A. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol. 1989 Aug;7(8):1157–1168. doi: 10.1200/JCO.1989.7.8.1157. [DOI] [PubMed] [Google Scholar]
  19. Rusch V. W. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest. 1995 Oct;108(4):1122–1128. doi: 10.1378/chest.108.4.1122. [DOI] [PubMed] [Google Scholar]
  20. Rusch V. W., Venkatraman E. The importance of surgical staging in the treatment of malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 1996 Apr;111(4):815–826. doi: 10.1016/s0022-5223(96)70342-2. [DOI] [PubMed] [Google Scholar]
  21. Samson M. K., Wasser L. P., Borden E. C., Wanebo H. J., Creech R. H., Phillips M., Baker L. H. Randomized comparison of cyclophosphamide, imidazole carboxamide, and adriamycin versus cyclophosphamide and adriamycin in patients with advanced stage malignant mesothelioma: a Sarcoma Intergroup Study. J Clin Oncol. 1987 Jan;5(1):86–91. doi: 10.1200/JCO.1987.5.1.86. [DOI] [PubMed] [Google Scholar]
  22. Spirtas R., Connelly R. R., Tucker M. A. Survival patterns for malignant mesothelioma: the SEER experience. Int J Cancer. 1988 Apr 15;41(4):525–530. doi: 10.1002/ijc.2910410409. [DOI] [PubMed] [Google Scholar]
  23. Sterman D. H., Kaiser L. R., Albelda S. M. Advances in the treatment of malignant pleural mesothelioma. Chest. 1999 Aug;116(2):504–520. doi: 10.1378/chest.116.2.504. [DOI] [PubMed] [Google Scholar]
  24. Sugarbaker D. J., Flores R. M., Jaklitsch M. T., Richards W. G., Strauss G. M., Corson J. M., DeCamp M. M., Jr, Swanson S. J., Bueno R., Lukanich J. M. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999 Jan;117(1):54–65. doi: 10.1016/s0022-5223(99)70469-1. [DOI] [PubMed] [Google Scholar]
  25. Sugarbaker D. J., Norberto J. J., Swanson S. J. Surgical staging and work-up of patients with diffuse malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. 1997 Oct;9(4):356–360. [PubMed] [Google Scholar]
  26. Thurston D. E. Nucleic acid targeting: therapeutic strategies for the 21st century. Br J Cancer. 1999 Jul;80 (Suppl 1):65–85. [PubMed] [Google Scholar]
  27. Yates D. H., Corrin B., Stidolph P. N., Browne K. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. 1997 Jun;52(6):507–512. doi: 10.1136/thx.52.6.507. [DOI] [PMC free article] [PubMed] [Google Scholar]

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