A Nomogram to Predict Prognosis in Malignant Pleural Mesothelioma

Our plain-English summary of A Nomogram to Predict Prognosis in Malignant Pleural Mesothelioma, by S. Wang, K. Ma, Z. Chen, et al (World Journal of Surgery, 2018).

The study

• Authors: S. Wang, K. Ma, Z. Chen, X. Yang, F. Sun, Y. Jin, Y. Shi, W. Jiang, Q. Wang, C. Zhan
• Journal: World Journal of Surgery
• Published: 2018;42(7):2134-2142
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare malignancy with heterogeneous outcomes. This study was aimed to develop a nomogram to precisely and visually predict survival of MPM patients.

Methods: Data from Surveillance, Epidemiology, and End Results database (1973-2014) on MPM were screened and retrieved. The prognostic effects of variables, including age, sex, race, year of diagnosis, laterality, histology, tumor stage, surgery, chemotherapy, and radiotherapy were analyzed using Kaplan-Meier method and Cox proportional hazard model. A nomogram was formulated to predict overall survival of MPM patients.

Results: A total of 1092 cases who met inclusion criteria were included in this study. The overall 1-, 2-, and 3-year survival rate in the entire cohort was 45.1, 23.0, and 12.1%, with median survival of 11 months. Cox regression analysis showed that age (P < 0.001), race (P = 0.003), histology type (P < 0.001), T stage (P < 0.001), M stage (P < 0.001), TNM stage (P < 0.001), cancer-directed surgery (P < 0.001), and chemotherapy (P < 0.001) were all independent prognostic factors of MPM patients. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram had sufficient discriminatory power with the C-index of 0.705 (95% CI 0.681-0.729). The calibration plots also demonstrated good consistence between the prediction and the observation.

Conclusions: We developed a nomogram to accurately predict clinical outcomes of MPM patients based on individual characteristics. Risk stratification by the survival nomogram could optimize individual therapies and follow-up.

In plain English

This study used the U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry to build a nomogram, a scoring chart that estimates a patient's chance of survival, for malignant pleural mesothelioma. Of 15,476 patients in the database, the authors kept 1092 who had a confirmed diagnosis and complete stage, histology and treatment records. All of them were diagnosed from 2010 to 2014. The study did not look at asbestos exposure. Median survival was 11 months. Survival at 1, 2 and 3 years was 45.1%, 23.0% and 12.1%. In the multivariate analysis, age, race, histology type, T stage, M stage, TNM stage, cancer-directed surgery and chemotherapy were independent prognostic factors. Sex and radiotherapy were linked to survival only when each factor was tested on its own. N stage, which describes lymph node spread, was not a prognostic factor. The nomogram's C-index, a measure of how well it ranks patients by risk, was 0.705 (95% CI 0.681 to 0.729). The authors concluded the nomogram was a useful tool for predicting survival. They noted that only 7.1% of SEER patients were included and that SEER lacked some staging and tissue-subtype detail.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a population-based cancer registry database (SEER), used to identify prognostic factors and build and internally validate a survival nomogram
• Who was studied: 1092 patients with malignant pleural mesothelioma from U.S. SEER registries, all diagnosed 2010 to 2014, selected from 15,476 MPM patients in the database (1973 to 2014). Patients diagnosed before 2010 were excluded under the inclusion and exclusion criteria.
• Exposure: No asbestos exposure was studied. The factors examined were patient, tumor and treatment characteristics: age, sex, race, year of diagnosis, laterality, histology, tumor stage, surgery, chemotherapy and radiotherapy.
• Main results:
  • In the whole cohort of 1092 patients, median survival was 11 months, and 1-, 2- and 3-year overall survival was 45.1%, 23.0% and 12.1%.
  • 3-year overall survival by TNM stage was 25.5% for stage IA, 15.6% for IB, 15.0% for II, 16.5% for III and 6.3% for IV.
  • In multivariate analysis, age, race, histology type, T stage, M stage, TNM stage, cancer-directed surgery and chemotherapy were independent prognostic factors of overall survival.
  • Compared with epithelioid histology, the multivariate hazard ratio for death was 2.539 (95% CI 2.114 to 3.048) for sarcomatoid and 1.534 (1.259 to 1.868) for biphasic histology.
  • Compared with no surgery, the multivariate hazard ratio was 0.598 (95% CI 0.465 to 0.769) for curative surgery and 0.705 (0.597 to 0.834) for palliative surgery. For patients who received chemotherapy compared with those who did not, it was 0.720 (0.617 to 0.839).
  • Sex and radiotherapy were significant in univariate analysis (P = 0.013 and P = 0.038) but not in multivariate analysis (P = 0.101 and P = 0.838).
  • Year of diagnosis, laterality and N stage were not prognostic factors (N stage P = 0.390).
  • The nomogram's C-index for predicting overall survival, from internal bootstrap resampling, was 0.705 (95% CI 0.681 to 0.729).
• The authors' conclusion: The authors concluded that the nomogram, based on age, race, histology, T stage, M stage, surgery and chemotherapy, was a useful tool for risk assessment and visual survival prediction for MPM patients.
• Limitations the authors state:
  • Only 7.1% of MPM patients in the SEER database were included, mainly because of missing stage information. The authors reported that the included patients did not differ significantly in key characteristics from all SEER MPM patients.
  • SEER mixes clinical and pathological staging, so the TNM stage findings may be underpowered.
  • Clinical and pathological N stage are not clearly distinguished in SEER, which may explain why no survival differences by N stage were found.
  • Subtypes within epithelioid MPM could not be examined because SEER lacks morphologic information.
  • The radiotherapy findings may be confounded by different radiotherapy techniques and doses, and the study was retrospective.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Mesothelioma, Epidemiology, Histology, Chemotherapy, Overall Survival, Median Survival, Multivariate Analysis.

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