Prognostic factors in malignant pleural mesothelioma (MPM): A mono-institutional evaluation of Bologna Malignant Pleural Mesothelioma Group.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Daniela Adua ◽  
Francesca Sperandi ◽  
Paolo Castellucci ◽  
Barbara Melotti ◽  
Stefania Giaquinta ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Malignant Pleural Mesothelioma ◽  
Cox Regression ◽  
Statistical Significance ◽  
Multimodality Treatment ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma ◽  
Histological Subtype ◽  
The Impact

e18509 Background: The prognostic systems currently in use in MPM, such as the EORTC and CALGB score, include the clinical and histological parameters, excluding the FDG-PET (PET) evaluation and the possibility of surgery. The aim of our study was to investigate the role of PET baseline SUV-max and surgery as prognostic factors in MPM. Methods: From April 2002to December 2012, 48 pts with a certain histological diagnosis of MPM underwent staging by PET scan before peri-operative (multimodality treatment) or palliative first-line chemotherapy (CT). Surgery was performed in 22(45.8%) pts. Pt characteristics: males 44(91.7%), females 4(8.3%); median age 65 (51-77) years; ECOG PS 0-1 45(93.7 %), PS 2 3(6.3 %); IMIG stage I-II 18(37.5%), III-IV 30(62.5%); histological subtype epithelial 40(83.3%), mixed 5(10.4%), sarcomatoid 3(6.3%); extrapleural pneumonectomy 8(16.8%), pleurectomy/decortication 14(29.2%), 17 (35.4%) VATS plus pleurodesis, 19(39.6%) no surgical procedures. Platinum based CT was performed in combination with pemetrexed in 39(81.3%) pts and with gemcitabine in 9(18.7%). According to the EORTC score 30(62.5%) pts were classified in the good prognosis group and 18(37.5%) as poor prognosis. The cut-off value of PET baseline SUV-max calculated by ROC analysis was 9; SUV-max at baseline PET was ≤ 9 in 32(66.7%) pts and >9 in 16(33.3%). Median overall survival (OS) was 12 (3-60) months. Results: Upon validating the impact of individual factors on OS using the Kaplan-Meier analysis, we found statistical significance was reached by histology (p=0.0038) and surgery (p=0.0027). In a multivariate analysis using the Cox regression system, considering OS as a dependent variable, according to age, histology, stage, PET baseline SUV-max and surgery, epithelial histology (p =0.002) and surgery (p=0.012) achieved a statistical significance. SUV-max at baseline PET was not statistically significant (p = 0.290), excluding it as a possible independent prognostic factor in MPM. Conclusions: This analysis does not indicate any prognostic value for baseline PET in MPM, confirming the importance of histological subtype and introducing surgery as a possible prognostic factor.

scholarly journals Multimodality treatment of malignant pleural mesothelioma

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1681 ◽  
Author(s):  
Lawek Berzenji ◽  
Paul Van Schil
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Asbestos Exposure ◽  
Multimodality Treatment ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma ◽  
Treatment Approaches ◽  
Definitive Answer ◽  
Platinum Based Chemotherapy

Malignant pleural mesothelioma (MPM) is a rare disease of the pleura and is largely related to asbestos exposure. Despite recent advancements in technologies and a greater understanding of the disease, the prognosis of MPM remains poor; the median overall survival rate is about 6 to 9 months in untreated patients. The main therapeutic strategies for MPM are surgery, chemotherapy, and radiation therapy (RT). The two main surgical approaches for MPM are extrapleural pneumonectomy (EPP), in which the lung is removed en bloc, and pleurectomy/decortication, in which the lung stays in situ. Chemotherapy usually consists of a platinum-based chemotherapy, such as cisplatin, often combined with a folate antimetabolite, such as pemetrexed. More recently, immunotherapy has emerged as a possible therapeutic strategy for MPM. Evidence suggests that single-modality treatments are not an effective therapeutic approach for MPM. Therefore, researchers have started to explore different multimodality treatment approaches, in which often combinations of surgery, chemotherapy, immunotherapy, and RT are investigated. There is still no definitive answer to the question of which multimodality treatment combinations are most effective in improving the poor prognosis of MPM. Research into the effects of trimodality treatment approaches have found that radical approaches such as EPP and hemithoracic RT post-EPP are less effective than was previously assumed. In general, there are still a great number of unanswered questions and unknown factors regarding the ideal treatment approach for MPM. Hopefully, more research into multimodality therapy will provide insight into which combination of treatment modalities is most effective.

scholarly journals Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy

2021 ◽  
Vol 10 (5) ◽  
pp. 1134
Author(s):  
Alice Bellini ◽  
Andrea Dell’Amore ◽  
Stefano Terzi ◽  
Giovanni Zambello ◽  
Andrea Zuin ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Treatment Strategies ◽  
Multimodality Treatment ◽  
Best Supportive Care ◽  
Frequent Pattern ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma ◽  
Appropriate Treatment ◽  
Study Population ◽  
Distant Spread

To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR 0.491, IC95% 0.263–0.916), local failure (p = 0.027, HR 0.707, IC95% 0.521–0.961), DFS ≥ 12 months (p = 0.006, HR 0.298, IC95% 0.137–0.812) and post-recurrence medical treatment (p = 0.046, HR 0.101, IC95% 0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.

scholarly journals Malignant Pleural Mesothelioma

2009 ◽  
Vol 27 (12) ◽  
pp. 2081-2090 ◽  
Author(s):  
Anne S. Tsao ◽  
Ignacio Wistuba ◽  
Jack A. Roth ◽  
Hedy Lee Kindler
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Median Overall Survival ◽  
Intensity Modulated Radiotherapy ◽  
The United States ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma ◽  
Controversial Issues ◽  
Significant Progress ◽  
The Impact

Malignant pleural mesothelioma (MPM) is a deadly disease that occurs in 2,000 to 3,000 people each year in the United States. Although MPM is an extremely difficult disease to treat, with the median overall survival ranging between 9 and 17 months regardless of stage, there has been significant progress over the last few years that has reshaped the clinical landscape. This article will provide a comprehensive discussion of the latest developments in the treatment of MPM. We will provide an update of the major clinical trials that impact mesothelioma treatment in the resectable and unresectable settings, discuss the impact of novel therapeutics, and provide perspective on where the clinical research in mesothelioma is moving. In addition, there are controversial issues, such as the role of extrapleural pneumonectomy, adjuvant radiotherapy, and use of intensity-modulated radiotherapy versus hemithoracic therapy that will also be addressed in this manuscript.

Survival and prognostic factors in patients with malignant pleural mesothelioma (MPM) treated with neoadjuvant cisplatin- based chemotherapy and extrapleural pneumonectomy (EPP) (SITMP Study)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18061-18061
Author(s):  
V. Mutri ◽  
C. Pinto ◽  
A. Marino ◽  
M. Di Bisceglie ◽  
D. Dell’Amore ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Preoperative Chemotherapy ◽  
Cox Regression ◽  
Objective Response ◽  
Resection Margins ◽  
Extrapleural Pneumonectomy ◽  
Cox Regression Analysis ◽  
Group A ◽  
Group B ◽  
The Impact

18061 Background: The aim of this study is to evaluate the impact on survival of preoperative chemotherapy in potentially resectable MPM and correlations with prognostic factors. Methods: The eligibility criteria were: histologically MPM, stage T1–3N0–2M0, age =75 years, KPS = 80, adequate organ function. A first group of pts (group A) received cisplatin 75 mg/m2 d1 and gemcitabine 1,200 mg/m2 d1,8, every 3 weeks for 4 courses, followed by EPP and by 6 courses of adjuvant chemotherapy with mitoxantrone 10 mg/m2 d1, methotrexate 35 mg/m2 d1 and mitomycin 7 mg/m2 d1, every 3 weeks with mitomycin in alternate cycles. A second group of pts (group B) received cisplatin 75 mg/m2 d1 plus pemetrexed 500 mg/m2 d1 for 4 cycles. In each group, only those pts with metastatic lymph nodes and/or positive resection margins received radiotherapy after EPP. The prognostic factors evaluated were: sex, histotype, stage at diagnosis, clinical objective response. Results: Between February 2000 and December 2006, 32 pts were enrolled (8 group A, 24 group B). Pt characteristics were: 27M (84.4%), 5F (15.6%), median age 64 years (51–72), median KPS 100 (80–100), histological subtype: 27 (84.4%) epithelial, 2 (6.3%) sarcomatous, 3 (9.4%) mixed; IMIG stage: 6 (18.8%) I, 16 (50%) II, 10 (31.2%) III. The clinical response to neoadjuvant chemotherapy was: 10 (31.3%) CR + PR, 16 (50%) SD and 6 (18.7%) PD. Eighteen (56.3%) pts underwent EPP. In the 14 pts who did not undergo EPP: 5 (15.6%) were treated with pleurectomy and 9 (28.1%) were not treated with surgery. Two postoperative deaths (1 contralateral pneumonia and 1 ARDS) occurred after EPP. No pts were treated with radiotherapy after EPP. The estimated median overall survival, 1-year and 2-year survival rates in the pts treated with EPP and not treated with EPP were 20 and 12 months (p=0.468), 60 and 41%, 42 and 20%, respectively. In the multivariate analysis (Cox regression analysis), none of evaluated prognostic factors was significantly associated with an improved OS. Conclusions: These data show that preoperative chemotherapy followed by EPP is a feasible approach, while initial analysis suggests favourable survival. No significant prognostic factors were identified. No significant financial relationships to disclose.

scholarly journals Survival of Korean Patients with Malignant Pleural Mesothelioma Compensated for the Asbestos Injury Relief

2021 ◽  
Vol 11 (20) ◽  
pp. 9713
Author(s):  
Min-Sung Kang ◽  
Sung-Soo Lee ◽  
Soon-Chan Kwon ◽  
Da-An Huh ◽  
Yong-Jin Lee
Keyword(s):  
Prognostic Factors ◽  
Occupational Exposure ◽  
Malignant Pleural Mesothelioma ◽  
Malignant Mesothelioma ◽  
Asbestos Exposure ◽  
Performance Status ◽  
Smoking History ◽  
Pleural Mesothelioma ◽  
Histological Subtype ◽  
Epidemiologic Characteristics

Background: The purpose of this study was to identify the epidemiologic characteristics and prognostic factors for malignant pleural mesothelioma in Korea, which are currently insufficient. The data were derived from malignant mesothelioma patients who registered under the Asbestos Injury Relief Act; Methods: A total of 728 patients received compensation from the Asbestos Injury Relief Act due to malignant mesothelioma between 2011 and 2015. Of these, 313 patients (43.0%) with malignant pleural mesothelioma were included in the study. The study variables were sex (male, female), age at diagnosis (<59, 60–69, ≥70), smoking history (yes, no), surgery (yes, no), chemotherapy (yes, no), occupational exposure to asbestos (yes, no), and histological subtype (epithelioid, nonepithelioid); Results: Median survival of mesothelioma was 8.0 months (95% confidence interval: 6.2 to 9.8). The 1-year, 2-year, and 5-year survival rates (%) were 43.5%, 23.6%, and 12.5%, respectively. In multivariate analysis of Cox’s proportional hazards model; sex, age, smoking history, occupational asbestos exposure, and histological subtype were not significant prognostic factors, but surgery and chemotherapy combined was a significant predictor; Conclusions: Although the representativeness of these data is limited, our study estimates the epidemiologic characteristics of malignant pleural mesothelioma. Non-occupational exposure had a similar prognosis to occupational asbestos exposure, and there was no sex difference. In addition, it was found that receiving a combination of surgery and chemotherapy affects the survival rate, but there is a limitation in that factors such as performance status, comorbidities, and stage that contribute to survival are not considered.

Analysis of survival of patients with metastatic malignant pleural mesothelioma

2020 ◽  
pp. 030089162092623
Author(s):  
Andrea Bille ◽  
Lawrence Okiror ◽  
Leanne Harling ◽  
Fausto Pernazza ◽  
Alberto Muzio ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Malignant Pleural Mesothelioma ◽  
Cox Regression ◽  
Locally Advanced ◽  
Hazard Ratio ◽  
Pleural Mesothelioma ◽  
Female Sex ◽  
Propensity Matching ◽  
Relationship Of

Aim: To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment. Methods: This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect. Results: There were 367 patients included with a median age of 71 years (range, 29–91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2–24.6 months) and 0% versus 20.2 months (95% CI, 16.7–23.3 months) and 33%, respectively ( p = 0.029). Female sex, age >70 years, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors. There was no difference in OS of patients with locally advanced (T4) disease compared to metastatic disease (M1): median OS 10.7 months (95% CI, 5.9–15.6) versus 13.3 months (95% CI, 2–24.6) ( p = 0.18), respectively. Following propensity matching, sarcomatoid histology (hazard ratio, 7.86 [95% CI, 3.64–16.95]; p < 0.001) and multiple lines of chemotherapy (hazard ratio, 0.38 [95% CI, 0.19–0.84]; p = 0.015) were significant independent prognostic factors for OS. Conclusions: T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.

scholarly journals Extrapleural pneumonectomy for malignant pleural mesothelioma: Outcomes of treatment and prognostic factors

2009 ◽  
Vol 138 (3) ◽  
pp. 619-624 ◽  
Author(s):  
Tristan D. Yan ◽  
Michael Boyer ◽  
Mo Mo Tin ◽  
Daniel Wong ◽  
Catherine Kennedy ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Malignant Pleural Mesothelioma ◽  
Extrapleural Pneumonectomy ◽  
Pleural Mesothelioma
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