Prognostic Factors for Mesothelioma
Section snippets
Clinical prognostic factor scoring systems
The best known published prognostic scoring systems are those of the European Organization for the Research and Treatment of Cancer (EORTC) [12] and the Cancer and Leukemia Group B (CALGB) in the United States [13]. These systems show that the most important predictors of poor prognosis in pleural mesothelioma are poor performance status, non-epithelioid histology, male gender, low hemoglobin, high platelet count, high white blood cell count, and high lactate dehydrogenase level. These systems
University of Leicester Hospitals, Leicester, England
In 2000, Edwards and colleagues [14] of Leicester, England, published a retrospective analysis of a series of 142 patients who had mesothelioma. Some of these patients had surgical intervention, whereas others were treated with chemotherapy or supportive care alone. Univariate analysis of prognostic variables was performed using a Cox proportional hazards regression model. Statistically significant variables were analyzed further in a stepwise multivariate model. The authors then derived EORTC
Molecular prognostic markers in malignant mesothelioma
In the last 3 years, pivotal research has been published on the molecular genetic profile of malignant mesothelioma. Data acquired by genomics technology should produce fundamental insights into all aspects of the tumor's biology. Prognostication and treatment will improve when the key genetic events in mesothelioma initiation and propagation are understood. Mesothelioma has an unusual molecular biology, with loss of tumor suppressor genes being especially significant. The P16INK4A, P14ARF, and
Predictors of survival in patients treated surgically
A brief review of the surgical prognostic predictors is included from the two largest series available. From 1980 to 1997, 183 patients underwent EPP followed by adjuvant chemotherapy and radiotherapy (various protocols were used) at Brigham and Women's Hospital in Boston [4], [6]. There were seven (3.8%) acute deaths, and a morbidity rate of 50% was quoted. The 2-year survival rate was 38% in the 176 remaining patients. The 5-year survival rate was 15% and the median overall survival was 19
Other prognostic predictors for mesothelioma
PET is established as an important staging modality in many cancers, and PET standard update value (SUV) is reported as a prognostic indicator in several malignancies. The role of PET in prognostication of mesothelioma is unclear, however. From 1998 to 2003, 65 patients who had pleural mesothelioma at Memorial Sloan-Kettering Cancer Center underwent PET scans [29]. Median PET SUV in the primary tumor was 6.6 (range, 2–23), and the median follow-up for all surviving patients was 16 months.
Summary
Knowledge of the clinical behavior, treatment, and molecular biology of malignant mesothelioma is accumulating rapidly. The disease is no longer considered an untreatable rarity but rather is an interesting disease of known origin (in most cases) that will provide crucial insights into cancer biology. Treatment is improving, with palliative two-drug chemotherapy being an established approach for fitter patients. A small proportion of patients are candidates for radical surgery, although
Acknowledgments
The author thanks the following persons for their assistance in providing data for this article: Raja Flores, MD (New York, NY) and Dean Fennell, MD, PhD (Belfast, Northern Ireland).
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