Survival in Good Performance Malignant Pleural Mesothelioma Patients; Prognostic Factors and Predictors of Response

Our plain-English summary of Survival in Good Performance Malignant Pleural Mesothelioma Patients; Prognostic Factors and Predictors of Response, by M. Rahouma, H. Aziz, G. Ghaly, et al (Asian Pacific Journal of Cancer Prevention, 2017).

The study

• Authors: M. Rahouma, H. Aziz, G. Ghaly, M. Kamel, I. Loai, A. Mohamed
• Journal: Asian Pacific Journal of Cancer Prevention
• Published: 2017;18(8):2073-2078
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Malignant pleural mesothelioma (MPM) has a poor prognosis in general. Here we sought to evaluate prognostic factors and predictors of response to chemotherapy in good performance (PS=0-I) patients. Methods: We retrospectively reviewed our database and enrolled patients with MPM who received platinum containing chemotherapy (2012-2014). Clinico-pathological and laboratory data were retrieved and Cox and logistic regression multivariate analyses (MVA) were respectively used to identify predictors of survival and response to chemotherapy. Comparison of good vs poor performance status (PS≥II) was accomplished using the Chi (X2) test. Kaplan–Meier survival curves were also obtained and propensity-score matching was performed for survival comparison. Results: Among 114 patients listed during the study period, 82 had good PS=0-I (median age 45years, 43 men, 30 smokers, median weight=77Kg, pretreatment haemoglobin (Hb) level=12g/dL, platelet count=372,000/μL, leukocytes=9,700/μL, neutrophils=6,100/μL, lymphocytes=1,890/μL and neutrophil/lymphocyte ratio (NLR)=3.60 ). Some 65 had asbestosis, 23 had chronic disease, 55 (67.1%) were responders to platinum containing first line chemotherapy. A total of 49 (59.8%) had epithelial MPM. Median-OS and PFS in good PS cases were 17 and 9 months, respectively, as compared to 16 and 8 months for the poor PS group. After matching, better OS was observed among good PS vs poor PS patients (p=0.024) but there was no PFS difference (p=0.176). Significant decrease in PFS was observed among those with advanced nodal N disease (median PFS in N0 and N+ was 10 and 5 months, respectively), non-responders (p=0.012), NLR (p=0.026) and those with an epithelial pathology (p=0.062). MVA demonstrated that advanced (N) status (p=0.015), being a non-responder (p<0.001), NLR (p=0.015) and smoking (p=0.07) adversely affected the prognosis. The only predictor of response was absence of metastasis (M0; p=0.04). Conclusions: In addition to previously recognized factors, like nodal status, response, smoking and NLR, better median survival was evident in our patients with a good PS. Early detection before development of metastasis warrants greater focus to allow better responses to be obtained.

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In plain English

This retrospective study reviewed 114 patients with malignant pleural mesothelioma given platinum-containing chemotherapy at the National Cancer Institute, Cairo University, Egypt, between January 2012 and December 2014. Of these, 82 had good performance status (ECOG 0 to I) and 32 poor. Among the 82, 65 were recorded under asbestos (text: "asbestosis"; table: "Asbestos") and 55 (67.1%) responded to chemotherapy. Their median overall survival was 17 months (95% CI 14.1 to 19.9) and progression-free survival 9 months (95% CI 7 to 11.03). The poor-performance group had 16 months (95% CI 12.7 to 19.3) and 8 months (95% CI 6.6 to 9.4). These differences were not statistically significant. After matching 29 patients per group, median overall survival was 19 versus 16 months (p=0.024). In the good-performance group, multivariate analysis linked lymph node spread, non-response to chemotherapy and a higher neutrophil/lymphocyte ratio to shorter progression-free survival; smoking had p=0.07. Absence of metastasis was the only independent predictor of response. The authors concluded that better median survival was evident with good performance status and that early detection before metastasis is warranted.

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 review of a hospital database and medical records, with Cox and logistic regression and propensity-score matching
• Who was studied: 114 patients with pathologically confirmed malignant pleural mesothelioma, evaluated and treated between January 2012 and December 2014 at the National Cancer Institute, Cairo University, Egypt. 82 had good performance status (ECOG 0 to I) and 32 had poor performance status (ECOG II or higher). Excluded were patients with peritoneal mesothelioma, patients treated at another hospital, patients lost to follow-up, and patients who had decortication or extrapleural pneumonectomy.
• Exposure: The study examined platinum-containing first-line chemotherapy, not asbestos as such. Documented asbestos exposure was one of the variables analyzed. 65 of the 82 good-performance patients (79.3%) were recorded under asbestos: the text calls this "asbestosis" and the table labels it "Asbestos". No fiber types were reported.
• Main results:
  • Good-performance group (n=82): median overall survival 17 months (95% CI 14.1 to 19.9) and median progression-free survival 9 months (95% CI 7 to 11.03). Poor-performance group: 16 months (95% CI 12.7 to 19.3) and 8 months (95% CI 6.6 to 9.4).
  • Before matching, the difference in overall survival between good and poor performance groups was not statistically significant (p=0.383). For progression-free survival, p=0.121.
  • After propensity-score matching (29 patients per group), median overall survival was 19 months in the good-performance group versus 16 months in the poor-performance group (p=0.024). There was no difference in progression-free survival (p=0.176).
  • In the good-performance group, chemotherapy responders (partial or complete response) compared with non-responders: median overall survival 21 vs 15 months (p=0.026) and median progression-free survival 12 vs 6 months (p=0.007).
  • Multivariate analysis of progression-free survival in the good-performance group (n=82) identified four factors linked to worse prognosis:
• nodal spread (N+): HR 1.87 (95% CI 1.13 to 3.09), p=0.015
• non-response to chemotherapy: responders had HR 0.35 (0.20 to 0.62), p less than 0.001
• higher neutrophil/lymphocyte ratio: HR 1.010, p=0.015
• smoking: HR 1.59 (0.96 to 2.63), p=0.073
  • Predictors of response to chemotherapy in univariate analysis were absence of asbestosis (p=0.05), absence of fatigue (p=0.03), absence of metastasis (p=0.04) and lower platelet count (p=0.05). In multivariate analysis, only absence of metastasis remained significant (p=0.047).
  • The study did not find better survival with epithelial histology. Sarcomatoid or mixed histology had HR 0.64 (0.40 to 1.02, p=0.062) for progression-free survival in univariate analysis. The authors noted better survival in non-epithelial histology.
• The authors' conclusion: The authors concluded that pretreatment neutrophil/lymphocyte ratio is a potential prognostic marker and that better response to chemotherapy predicts better progression-free survival. They also concluded that smoking and advanced nodal stage hinder survival in good-performance patients, that better median survival was evident with good performance status, and that early detection before metastasis is warranted.
• Limitations the authors state:
  • The authors acknowledge unspecified limitations and confounding factors.
  • The authors suggest the unexpected histology result may partly reflect more advanced stage among their epithelial patients (IMIG stage 4 in 34.7% vs 24.2% of non-epithelial patients).

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Chemotherapy, Performance Status, Pathology, Metastasis, Median Overall Survival.

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