title: Prognostic factors in mesothelioma.
abstract: Prognostic factors can help clinicians and patients when deciding a treatment plan. Patients in the best prognostic groups can be considered for more intensive or experimental therapy. Alternatively, patients in the best prognostic groups might prefer a period of observation prior to commencement of therapy. For patients with mesothelioma prognostic factors are potentially especially important because of the lack of a widely applicable anatomical staging system. Both the International Mesothelioma Interest Group (IMIG) and Brigham staging systems are of limited relevance to patients not undergoing radical debulking surgery. Radiological prediction of IMIG or Brigham stage is of little value. Review of the best-known prognostic scoring systems from the EORTC and CALGB has shown that the most important predictors of poor prognosis are: poor performance status; non-epithelioid histology; male gender; low hemoglobin; high platelet count; high white blood cell count; and high lactate dehydrogenase (LDH). The EORTC model was validated at St Bartholomew's Hospital in a group of 145 patients treated in sequential phase II chemotherapy trials. For 70 patients treated with vinorelbine, those having the best EORTC prognosis had a median survival of 19.2 months [95% C.I.=14.7-23.7] compared to 9.9 months [95% C.I.=8.5-11.3] for those in the worst group. The suggestion is that all clinical and biological factors relevant to prognosis should be recorded prospectively in mesothelioma patients selected for clinical trials.
authors.affiliation: Mesothelioma Unit, Department of Medical Oncology, St. Bartholomew's Hospital and Medical College, London EC1A 7BE, UK. jeremy.steele@bartsandthelondon.nhs.uk
authors.forename: Jeremy P C
authors.initials: JP
authors.lastname: Steele
authors.forename: Astero
authors.initials: A
authors.lastname: Klabatsa
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fennell
authors.forename: Arben
authors.initials: A
authors.lastname: Palläska
authors.forename: Mike T
authors.initials: MT
authors.lastname: Sheaff
authors.forename: Marie T
authors.initials: MT
authors.lastname: Evans
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shamash
authors.forename: Robin M
authors.initials: RM
authors.lastname: Rudd
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000473:pathology*; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis
chemical_list: D000970:Antineoplastic Agents