A New Prognostic Index for Mesothelioma?

Researchers in Japan have come up with what they say is the most up-to-date way to accurately predict outcomes in newly-diagnosed malignant pleural mesothelioma patients.

Many factors can affect mesothelioma prognosis. Some of them are related to the patient’s overall health and disease stage or type while others have to do with the type of therapy the patient undergoes. Scientists at Kyoto University, Hyogo College of Medicine, and Fukushima Medical University analyzed the outcomes of 283 mesothelioma patients between 2007 and 2013 to determine which factors were most likely to impact their outcomes and to what degree.

“Existing prognostic indices for malignant pleural mesothelioma do not incorporate the recent advances in oncology care,” notes study author Yoshiko Kataoka with Kyoto University. “The purpose of this study was to provide a prognostic index for overall survival…in the recent clinical setting.”

A total of 228 of the mesothelioma patients studied had chemotherapy with pemetrexed and a platinum drug like cisplatin. The remaining 55 patients had best supportive care to alleviate their symptoms. The findings indicated that the patients with the worst outcomes were the chemotherapy patients who were in less than ideal overall health (a “performance status” above 0), non-epithelioid mesothelioma subtype, and advanced disease.

Using this data, the researchers devised a way to predict outcomes in future mesothelioma patients by counting the above risk factors and assigning points for each one. Median overall survival in chemotherapy patients decreased by a predictable number of days, based on the number of points a patients had.

Patients with none of these prognostic risk factors had a median survival of 1030 days. Those with one risk factor had a median survival of 658 days. The median survival was 373 days for those with two of the risk factors, 327 for three, and 125 days for those who had all four. The predictive scale was consistent in case after case and worked equally well when applied to the “best supportive care” group.

“This novel index can provide clinicians and malignant pleural mesothelioma patients with a better framework for discussing prognosis at the time of diagnosis,” writes Dr. Kataoka. The study appears in a recent issue of the Japanese Journal of Clinical Oncology.

Source:

Kataoka, Y et al, “A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index”, April 2, 2015, Japanese Journal of Clinical Oncology, Epub ahead of print