title: A novel nomogram for peritoneal mesothelioma predicts survival.
abstract: BACKGROUND
  Malignant peritoneal mesothelioma (MPM) is a rare disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Estimation of personalized survival times can potentially guide treatment and surveillance.
  
  
  METHODS
  We analyzed 104 patients who underwent CRS and cisplatin-based HIPEC for MPM. By means of 25 demographic, laboratory, operative, and histopathological variables, we developed a novel nomogram using machine-learned Bayesian belief networks with stepwise training, testing, and cross-validation.
  
  
  RESULTS
  The mean peritoneal carcinomatosis index (PCI) was 15, and 66 % of patients had a completeness of cytoreduction (CC) score of 0 or 1. Eighty-seven percent of patients had epithelioid histology. The median follow-up time was 49 (1-195) months. The 3- and 5-year overall survivals (OS) were 58 and 46 %, respectively. The histological subtype, pre-CRS PCI, and preoperative serum CA-125 had the greatest impact on OS and were included in the nomogram. The mean areas under the receiver operating characteristic curve for the 10-fold cross-validation of the 3- and 5-year models were 0.77 and 0.74, respectively. The graphical calculator or nomogram uses color coding to assist the clinician in quickly estimating individualized patient-specific survival before surgery.
  
  
  CONCLUSIONS
  Machine-learned Bayesian belief network analysis generated a novel nomogram predicting 3- and 5-year OS in patients treated with CRS and HIPEC for MPM. Pre-CRS estimation of survival times may potentially individualize patient care by influencing the use of systemic therapy and frequency of diagnostic imaging, and might prevent CRS in patients unlikely to achieve favorable outcomes despite surgical intervention.
authors.affiliation: GI and Hepatobiliary Malignancies Section, Surgery Branch, National Cancer Institute/NIH, Bethesda, MD, USA.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Schaub
authors.forename: Meghna
authors.initials: M
authors.lastname: Alimchandani
authors.forename: Martha
authors.initials: M
authors.lastname: Quezado
authors.forename: Phil
authors.initials: P
authors.lastname: Kalina
authors.forename: John S
authors.initials: JS
authors.lastname: Eberhardt
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
authors.forename: Tatiana
authors.initials: T
authors.lastname: Beresnev
authors.forename: Raffit
authors.initials: R
authors.lastname: Hassan
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.forename: Prakash
authors.initials: P
authors.lastname: Pandalai
authors.forename: Giao Q
authors.initials: GQ
authors.lastname: Phan
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Udo
authors.initials: U
authors.lastname: Rudloff
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001185:Artificial Intelligence; D001499:Bayes Theorem; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
chemical_list: D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil