Fraser J H Brims1, Tarek M Meniawy2, Ian Duffus3, Duneesha de Fonseka4, Amanda Segal5, Jenette Creaney6, Nicholas Maskell4, Richard A Lake6, Nick de Klerk7, Anna K Nowak2. 1. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Institute for Respiratory Health, Perth, Australia. Electronic address: fraserbrims@uwa.edu.au. 2. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia. 3. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia. 4. Department of Respiratory Medicine, North Bristol National Health Service Trust, Bristol, United Kingdom. 5. PathWest Laboratory Medicine, Queen Elizabeth II Medical Campus, Perth, Australia. 6. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Australia. 7. Telethon Kids Institute, University of Western Australia, Perth, Australia.
Abstract
INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare cancer with a heterogeneous prognosis. Prognostic models are not widely utilized clinically. Classification and regression tree (CART) analysis examines the interaction of multiple variables with a given outcome. METHODS: Between 2005 and 2014, all cases with pathologically confirmed MPM had routinely available histological, clinical, and laboratory characteristics recorded. Classification and regression tree analysis was performed using 29 variables with 18-month survival as the dependent variable. Risk groups were refined according to survival and clinical characteristics. The model was then tested on an external international cohort. RESULTS: A total of 482 cases were included in the derivation cohort; the median survival was 12.6 months, and the median age was 69 years. The model defined four risk groups with clear survival differences (p < 0.0001). The strongest predictive variable was the presence of weight loss. The group with the best survival at 18 months (86.7% alive, median survival 34.0 months, termed risk group 1) had no weight loss, a hemoglobin level greater than 153 g/L, and a serum albumin level greater than 43 g/L. The group with the worst survival (0% alive, median survival 7.5 months, termed risk group 4d) had weight loss, a performance score of 0 or 1, and sarcomatoid histological characteristics. The C-statistic for the model was 0.761, and the sensitivity was 94.5%. Validation on 174 external cases confirmed the model's ability to discriminate between risk groups in an alternative data set with fair performance (C-statistic 0.68). CONCLUSIONS: We have developed and validated a simple, clinically relevant model to reliably discriminate patients at high and lower risk of death using routinely available variables from the time of diagnosis in unselected populations of patients with MPM.
INTRODUCTION:Malignant pleural mesothelioma (MPM) is a rare cancer with a heterogeneous prognosis. Prognostic models are not widely utilized clinically. Classification and regression tree (CART) analysis examines the interaction of multiple variables with a given outcome. METHODS: Between 2005 and 2014, all cases with pathologically confirmed MPM had routinely available histological, clinical, and laboratory characteristics recorded. Classification and regression tree analysis was performed using 29 variables with 18-month survival as the dependent variable. Risk groups were refined according to survival and clinical characteristics. The model was then tested on an external international cohort. RESULTS: A total of 482 cases were included in the derivation cohort; the median survival was 12.6 months, and the median age was 69 years. The model defined four risk groups with clear survival differences (p < 0.0001). The strongest predictive variable was the presence of weight loss. The group with the best survival at 18 months (86.7% alive, median survival 34.0 months, termed risk group 1) had no weight loss, a hemoglobin level greater than 153 g/L, and a serum albumin level greater than 43 g/L. The group with the worst survival (0% alive, median survival 7.5 months, termed risk group 4d) had weight loss, a performance score of 0 or 1, and sarcomatoid histological characteristics. The C-statistic for the model was 0.761, and the sensitivity was 94.5%. Validation on 174 external cases confirmed the model's ability to discriminate between risk groups in an alternative data set with fair performance (C-statistic 0.68). CONCLUSIONS: We have developed and validated a simple, clinically relevant model to reliably discriminate patients at high and lower risk of death using routinely available variables from the time of diagnosis in unselected populations of patients with MPM.
Authors: Michele Carbone; Prasad S Adusumilli; H Richard Alexander; Paul Baas; Fabrizio Bardelli; Angela Bononi; Raphael Bueno; Emanuela Felley-Bosco; Francoise Galateau-Salle; David Jablons; Aaron S Mansfield; Michael Minaai; Marc de Perrot; Patricia Pesavento; Valerie Rusch; David T Severson; Emanuela Taioli; Anne Tsao; Gavitt Woodard; Haining Yang; Marjorie G Zauderer; Harvey I Pass Journal: CA Cancer J Clin Date: 2019-07-08 Impact factor: 508.702
Authors: Michele Carbone; Harvey I Pass; Guntulu Ak; H Richard Alexander; Paul Baas; Francine Baumann; Andrew M Blakely; Raphael Bueno; Aleksandra Bzura; Giuseppe Cardillo; Jane E Churpek; Irma Dianzani; Assunta De Rienzo; Mitsuru Emi; Salih Emri; Emanuela Felley-Bosco; Dean A Fennell; Raja M Flores; Federica Grosso; Nicholas K Hayward; Mary Hesdorffer; Chuong D Hoang; Peter A Johansson; Hedy L Kindler; Muaiad Kittaneh; Thomas Krausz; Aaron Mansfield; Muzaffer Metintas; Michael Minaai; Luciano Mutti; Maartje Nielsen; Kenneth O'Byrne; Isabelle Opitz; Sandra Pastorino; Francesca Pentimalli; Marc de Perrot; Antonia Pritchard; Robert Taylor Ripley; Bruce Robinson; Valerie Rusch; Emanuela Taioli; Yasutaka Takinishi; Mika Tanji; Anne S Tsao; A Murat Tuncer; Sebastian Walpole; Andrea Wolf; Haining Yang; Yoshie Yoshikawa; Alicia Zolondick; David S Schrump; Raffit Hassan Journal: J Thorac Oncol Date: 2022-04-21 Impact factor: 20.121
Authors: Sanjeevan Muruganandan; Helman Alfonso; Peter Franklin; Keith Shilkin; Amanda Segal; Nola Olsen; Alison Reid; Nick de Klerk; Aw Bill Musk; Fraser Brims Journal: Br J Cancer Date: 2017-02-14 Impact factor: 7.640