Malignant mesothelioma, hypoalbuminaemia and the effect of carboplatin/pemetrexed on survival.
OBJECTIVE
The incidence of malignant mesothelioma in the UK is increasing. The aim of this study was to determine the prognostic factors and assess the effect of carboplatin/pemetrexed chemotherapy on survival.


METHODS
Cases of malignant mesothelioma diagnosed between 1998 and 2011 were stratified by year of diagnosis. Factors affecting survival were assessed by Cox's proportional hazards regression.


RESULTS
In total, there were 202 new cases of malignant mesothelioma between 1998 and 2011. The age-standardised rate (95% confidence interval) increased from 2.84 (2.06-3.60) to 4.44 (3.50-5.4); P = 0.025. Chemotherapy use has increased since 2006: 52% versus 34% (P = 0.007). The median survival (interquartile range) by year diagnosed was 9 (4.0-21.9) versus 10 (3.8-20.1) months for 1998-2005 versus 2006-2011. Independent predictors of survival [hazard ratio (95% confidence interval)] were: histology, sarcomatoid 2.22 (1.49-3.31) and unspecified non-epithelioid 1.50 (1.06-2.14); Eastern Cooperative Oncology Group performance status ≥3 2.86 (1.64-5.00); hypoalbuminaemia 2.07 (1.47-2.92), carboplatin/pemetrexed chemotherapy 0.56 (0.38-0.80).


CONCLUSIONS
The incidence of mesothelioma is increasing. Adverse prognostic factors include non-epithelioid histology, performance status and hypoalbuminaemia. Overall survival has not improved significantly, but treatment with carboplatin/pemetrexed chemotherapy is associated with a significant survival benefit.
Respiratory Medicine, Sunderland Royal Hospital, Sunderland, UK. Electronic address: murphsa@hotmail.com.
S
S
Murphy
G
G
Probert
J
J
Anderson
S
S
Pollock
I
I
Taylor
H
H
Clague
K
K
Sridharan
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005971:Glutamates / Q000008:administration & dosage / Q000009:adverse effects; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D000068437:Pemetrexed; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D016190:Carboplatin
Carboplatin; ECOG performance status; hypoalbuminaemia; mesothelioma; pemetrexed; prognosis