Development of a prognostic nomogram for patients with malignant mesothelioma with bone metastasis

Our plain-English summary of Development of a prognostic nomogram for patients with malignant mesothelioma with bone metastasis, by A. Yang, B. Tang, X. Liu, et al (Scientific Reports, 2023).

The study

• Authors: A. Yang, B. Tang, X. Liu, J. He, Q. Yan, X. Liang, W. Liu
• Journal: Scientific Reports
• Published: 2023;13(1):10789
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is a rare aggressive tumor, and bone metastasis often occurs in later stages of this disease. This study aimed to establish a nomogram to predict the prognosis of bone metastasis of patients with MM. Data from the Surveillance, Epidemiology, and End Results database were screened and retrieved. This study included 311 patients with MM with bone metastases. Prognostic factors were analyzed using the Kaplan-Meier method and Cox proportional hazards model. A nomogram for overall survival (OS) was established and evaluated using statistically significant prognostic factors, and cancer-specific survival (CSS) analysis was performed to investigate its prognostic factors. In addition, the metastasis patterns of patients with MM were investigated, and the effects of different sites of metastasis on survival were compared using the Kaplan-Meier method. Age, sex, histological type, and chemotherapy were identified as the independent risk factors for OS. The 1-, 2-, and 3-year areas under the curve of the nomogram were 0.792, 0.774, and 0.928, and 0.742, 0.733, and 0.733 in the training and validation sets, respectively. Compared to OS, histological type, radiotherapy, and chemotherapy were independent risk factors for CSS. Different metastatic sites in MM have significantly different effects on prognosis.

© 2023. The Author(s).

In plain English

This study used U.S. SEER registry records to build a nomogram, a survival-estimating chart, for malignant mesothelioma that had spread to bone. It included 311 patients diagnosed between 2000 and 2019. Of these, 80.71% were male and 86.5% had tumors starting in the pleura. Asbestos exposure was not analyzed. Sex, age, tumor tissue type and chemotherapy were independent risk factors for overall survival, though the authors noted the last two are not entirely independent, as tissue type influences chemotherapy decisions. Tissue type, radiotherapy and chemotherapy were independent risk factors for death from mesothelioma. The chart's 1-, 2- and 3-year areas under the curve, an accuracy measure, were 0.792, 0.774 and 0.928 in patients used to build it, and 0.742, 0.733 and 0.733 in test patients. Among 840 patients with distant spread, lung-only spread was most common (325 cases). Among the main single sites, liver spread had the best survival and bone the worst; the authors said more data are needed. The authors concluded the chart had satisfactory accuracy, noting it lacked outside testing, many values were missing, and SEER cannot separate no from unknown treatment.

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 U.S. cancer registry (SEER) to develop and internally validate a prognostic nomogram for overall survival
• Who was studied: 311 patients with microscopically confirmed malignant mesothelioma with bone metastases in the SEER database, diagnosed 2000 to 2019 (344 initially retrieved). They were split into a training set of 217 and a validation set of 94. A secondary cohort of mesothelioma cases with known metastatic sites was used to study metastasis patterns, including 840 patients with distant metastases.
• Exposure: Not an exposure study; asbestos exposure was not analyzed. The factors examined were demographic, tumor-related and treatment-related variables (surgery, lymph node surgery, radiotherapy, chemotherapy) and site of distant metastasis (bone, brain, liver, lung).
• Main results:
  • Among the 311 patients, most primary tumors were in the pleura (86.5%). Males were 80.71%.
  • In multivariate analysis, sex, age, histological type and chemotherapy were independent risk factors for overall survival. The authors noted that histology and chemotherapy are not entirely independent, because histology influences chemotherapy decisions.
  • Histological type, radiotherapy and chemotherapy were independent risk factors for cancer-specific survival.
  • Nomogram 1-, 2- and 3-year AUCs were 0.792, 0.774 and 0.928 in the training set, and 0.742, 0.733 and 0.733 in the validation set.
  • For a patient who was female, aged 65 or younger, with epithelioid histology and chemotherapy, the nomogram's corresponding 1-year survival rate was 50%.
  • Of 840 mesothelioma patients with distant metastases, single lung metastasis was most common: 325 cases (38.69%). Single bone metastasis was 22.98% and single liver metastasis 16.55%.
  • Among single bone, lung and liver metastases, survival differed. Liver metastasis had the best prognosis and bone metastasis the worst.
• The authors' conclusion: The authors concluded that age, sex, histological type and chemotherapy are independent risk factors for overall survival. They concluded that the nomogram based on these factors has satisfactory accuracy and may benefit clinical decision-making, and that different metastatic sites have significantly different effects on prognosis.
• Limitations the authors state:
  • No external validation, because no external dataset was available
  • Data integrity was hard to guarantee because of many missing values
  • SEER does not distinguish 'no' treatment from 'unknown' treatment
  • Histology and chemotherapy are not fully independent, because histology influences chemotherapy decisions
  • SEER records only four metastatic sites, while mesothelioma can spread elsewhere
  • More data are needed to support the finding on liver versus bone metastasis prognosis

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Metastasis, Prognosis, Epidemiology, Overall Survival, Chemotherapy.

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