Survival prediction in peritoneal mesothelioma: a nomogram based on SEER data and a Chinese cohort

Our plain-English summary of Survival prediction in peritoneal mesothelioma: a nomogram based on SEER data and a Chinese cohort, by Y. Fang, M. Xiang, Z. Jiang, et al (Frontiers in Endocrinology, 2024).

The study

• Authors: Y. Fang, M. Xiang, Z. Jiang, H. Li, G. Yuan, W. Pei, W. Li, Y. Sun
• Journal: Frontiers in Endocrinology
• Published: 2024;15:1432787
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: This study aimed to develop nomogram predicting overall survival (OS) of patients with peritoneal mesothelioma (PeM) using data from Surveillance, Epidemiology, and End Results (SEER) database and a Chinese institution.

Methods: 1,177 PeM patients from the SEER database were randomized into training and internal validation cohorts at a 7:3 ratio. An external validation cohort consisting of 109 patients was enrolled from a Chinese institution. Nomogram was constructed based on variables identified through multivariate Cox regression analysis and evaluated by consistency indices (C-index), calibration plots, and receiver operating characteristic (ROC) curves. Patients were stratified into different risk categories, and Kaplan-Meier survival analysis was used to assess OS differences among these groups.

Results: The nomogram, incorporating age, gender, histological type, T stage, M stage, and surgical status, demonstrated strong predictive capability with C-index values of 0.669 for the training cohort, 0.668 for the internal validation cohort, and 0.646 for the external validation cohort. The nomogram effectively stratified patients into high-risk and low-risk groups, with the high-risk group exhibiting significantly poorer OS (P < 0.05). Multivariate analysis confirmed gender, age, surgical intervention, and M stage as independent prognostic factors (P < 0.05). Specifically, male gender, older age, and unspecified M stage were linked to worse outcomes, while surgical intervention was associated with improved survival.

Conclusion: The nomogram provide a reliable tool for predicting the survival in PeM patients, facilitating more informed treatment decisions. Key independent prognostic factors include gender, age, surgical intervention, and M stage.

Copyright © 2024 Fang, Xiang, Jiang, Li, Yuan, Pei, Li and Sun.

In plain English

This retrospective study built and tested a nomogram, a scoring chart predicting overall survival, in peritoneal mesothelioma. It used 1,177 US SEER registry patients diagnosed 2004 to 2018, randomly split into training (823) and internal check (354) groups. A second check group was 109 Asian patients treated in Beijing from 2004 to 2022. Asbestos exposure was not studied; the authors noted the registry lacks it. In the training group, men had worse survival than women (hazard ratio 1.57, 95% confidence interval 1.30 to 1.91). So did patients aged 50 to 69 (1.82, 1.41 to 2.35) and over 69 (2.68, 2.05 to 3.49) versus under 50, and those with unspecified M stage versus M0 (1.52, 1.15 to 2.01). Surgery versus no surgery was linked to better survival (hazard ratio 0.52, 0.43 to 0.62). The concordance index was 0.669 (0.645 to 0.693), 0.668 (0.631 to 0.705) and 0.646 (0.575 to 0.717) in the three groups. The model separated high- from low-risk patients (p less than 0.001 in each group). The authors concluded that age, gender, surgery and M stage were independent prognostic factors.

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 registry and hospital data to build and validate a survival-prediction model (nomogram)
• Who was studied: 1,177 peritoneal mesothelioma patients from the US SEER database, diagnosed 2004 to 2018. They were randomly split into a training cohort (n = 823) and an internal validation cohort (n = 354). The external validation cohort was 109 Asian peritoneal mesothelioma patients treated from 2004 to 2022 at the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing.
• Exposure: No asbestos or fiber exposure was studied. The variables examined were clinical factors: age, gender, race, diagnosis period, histological type, TNM stage, metastases, surgery, chemotherapy and radiotherapy. The authors state the database does not include asbestos exposure.
• Main results:
  • Training cohort, multivariate analysis: male patients had a worse prognosis than female patients (HR 1.57, 95% CI 1.30-1.91, P < 0.001).
  • Training cohort, multivariate analysis, compared with patients younger than 50: those aged 50-69 had HR 1.82 (95% CI 1.41-2.35) and those over 69 had HR 2.68 (95% CI 2.05-3.49), both P < 0.001.
  • Training cohort, multivariate analysis: patients who had surgery had a better prognosis than those who did not (HR 0.52, 95% CI 0.43-0.62, P < 0.001).
  • Training cohort, multivariate analysis: patients with unspecified M stage had a poorer prognosis than M0 (HR 1.52, 95% CI 1.15-2.01, P = 0.003). M1 versus M0 was not statistically significant in the multivariate analysis (HR 1.08, 95% CI 0.51-2.29, P = 0.84; Table 2).
  • The final nomogram used six variables: age, gender, histological type, T stage, M stage and surgery. Its C-index was 0.669 (95% CI 0.645-0.693) in the training cohort and 0.668 (95% CI 0.631-0.705) in the internal validation cohort.
  • C-index in the external (Chinese) validation cohort: 0.646 (95% CI 0.575-0.717).
  • AUC values in the external validation cohort: 0.600 (95% CI 0.371-0.823) at 0.5 years, 0.774 (95% CI 0.643-0.904) at 1 year, 0.690 (95% CI 0.573-0.807) at 2 years and 0.743 (95% CI 0.612-0.874) at 5 years.
  • Patients were split into high-risk and low-risk groups at a relative-risk cut-off of 2.00. Overall survival differed between these groups with P less than 0.001 in the training, internal validation and external validation cohorts.
  • Chemotherapy was not associated with survival: univariate HR 0.96 (95% CI 0.81-1.13, P = 0.61) in the training cohort, and P = 0.70 in an exploratory analysis of patients who did not have surgery.
• The authors' conclusion: The authors concluded that they had developed and validated a nomogram for predicting overall survival in peritoneal mesothelioma patients, offering a more accurate basis for treatment decisions. They identified age, gender, surgical intervention and M stage as independent prognostic factors.
• Limitations the authors state:
  • SEER lacks specific information on chemotherapy regimens, targeted therapies and immunotherapy.
  • The database does not include ascites, tumor marker levels, asbestos exposure or socioeconomic factors.
  • Many variables, such as histological type and TNM staging, were recorded as Unknown, which may affect the model's accuracy.
  • Only 10 cases in the external cohort were non-epithelioid, which the authors say may explain why histological type was not significantly linked to survival.
  • Ethnic representation differed between cohorts: the external validation cohort was made up solely of Asian patients.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, SEER, Overall Survival, Epidemiology, Multivariate Analysis.

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