Predicting survival in mesothelioma patients does not have to be complicated. A new Parisian study suggests that simple-to-measure factors such as patient age and the histological subtype of the mesothelioma can be highly accurate prognostic indicators.
The study followed 170 patients diagnosed with malignant pleural mesothelioma between 2000 and 2010 at Saint Antoine Hospital in Paris. Patients in the study were all treated non-surgically. For each patient, a list of parameters was recorded including age, gender, tobacco use, asbestos exposure, type and duration of symptoms, BMI, C-reactive protein levels and white blood cell and platelet counts. Inflammation of the pleura (pachypleuritis) was also noted, along with the type of diagnostic surgical procedure, histological subtype, the way in which pleurodesis was performed (for treatment of excess lung fluid), and whether or not the patient had chemotherapy.
The goal of the study was to determine which of these factors played the most critical role in determining a mesothelioma patient’s odds of survival. For all patients involved, the median survival was 12 months. Twenty-six percent of patients were still alive at 2 years, 11% at 5 years, and 5% of patients lived for 7 years after their mesothelioma diagnosis.
The results showed that the level of asbestos exposure, the patient’s age, the histological subtype of their mesothelioma, levels of C-reactive protein in the blood, and white blood cell counts all had an impact on survival, independent of treatment modality. The American Society of Anesthesiologists (ASA) score, a measure of a patient’s overall fitness prior to surgery, was also influential. Older patients, those with nonepithelioid mesothelioma, those with an ASA score of III, those with C-reactive protein levels greater than 3 mg/L and leukocytosis (a higher-than-normal white blood cell count)above 12,000/mm were the least likely to do well.
Getting an accurate picture of prognosis can help clinicians decide which patients are the best candidates for certain kinds of treatments.
Baud, M, et al, “Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis”, May 2013, Journal of Thoracic and Cardiovascular Surgery, pp. 1305-1311.