title: A novel prognostic model for malignant mesothelioma incorporating quantitative FDG-PET imaging with clinical parameters.
abstract: OBJECTIVE
  Existing prognostic systems for malignant pleural mesothelioma do not incorporate imaging information. We aimed to identify the contribution of quantitative fluorodeoxyglucose positron emission tomography (FDG-PET) analysis to other prognostic variables in this disease.
  
  
  METHODS
  Patients with malignant pleural mesothelioma underwent helical thoracoabdominal computed tomography and FDG-PET scans at baseline. Patients were treated as clinically indicated and followed for survival. FDG-PET variables derived included total glycolytic volume, a composite of tumor volume and glycolytic activity.
  
  
  RESULTS
  Ninety-three patients were accrued from 2003 to 2006. Of 89 eligible assessable patients, 28 had undergone pleurodesis before enrolment. Seventeen patients remained alive at analysis; median survival is 15.4 months. On univariate analysis, significant prognostic factors were: total glycolytic volume on FDG-PET (P = 0.003), sarcomatoid histology (P < 0.0005), weight loss (P = 0.031), computed tomography stage (P = 0.015), and European Organization for Research and Treatment of Cancer good prognostic score (P = 0.049). In patients with epithelioid or biphasic histology, baseline total glycolytic volume remained predictive of survival in patients with (P = 0.01) or without (P = 0.018) previous pleurodesis. In multivariate analysis, no variable other than histology contributed to the model in patients with sarcomatoid histology; total glycolytic volume and weight loss contributed to the models in patients with nonsarcomatoid histology. computed tomography-assessed tumor-node-metastasis stage did not contribute to the model. A nomogram, which incorporates quantitative PET parameters and pleurodesis into prognostic information, is presented.
  
  
  CONCLUSIONS
  Sarcomatoid histology remains the strongest prognostic factor. In patients with non sarcomatoid disease, volumetric FDG-PET parameters are more predictive of survival than tumor-node-metastasis staging, suggesting that tumor volume and glycolytic activity may be more important determinants of prognosis in malignant pleural mesothelioma than anatomic extent of disease.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Nowak
authors.forename: Roslyn J
authors.initials: RJ
authors.lastname: Francis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Phillips
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Millward
authors.forename: Agatha A
authors.initials: AA
authors.lastname: van der Schaaf
authors.forename: Jan
authors.initials: J
authors.lastname: Boucek
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Musk
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: McCoy
authors.forename: Amanda
authors.initials: A
authors.lastname: Segal
authors.forename: Peter
authors.initials: P
authors.lastname: Robins
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Byrne
mesh_terms: D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000473:pathology; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18