title: Stratification of malignant pleural mesothelioma prognosis using recursive partitioning analysis.
abstract: OBJECTIVE
  Prognostic factors and complicated prognostic models have been proposed for malignant pleural mesothelioma (MPM). This study was designed to stratify MPM prognosis by using a simple model.
  
  
  METHODS
  Patients diagnosed with MPM in the past 10 years (n = 122) were examined retrospectively. Data on the presence of chest pain, performance status (PS), asbestos exposure, smoking status, white blood cell count (WBC), haemoglobin (Hb) concentration, platelet count (PLT), lactate dehydronate (LD), histology, stage, and date of death or censored status were collected. After the factors were examined in the univariate analysis, recursive partitioning analysis was performed.
  
  
  RESULTS
  Statistically significant factors related to survival were the type of histology, stage, PS, WBC, PLT, Hb concentration, and LD. Histology, stage, PS, and Hb concentration were used in multivariate analysis. Stage and Hb concentration showed good statistical significance, whereas PS was borderline significant. The survival analyses were stratified into five groups by PS, stage, Hb concentration, and chest pain using recursive partitioning analysis. Group A comprised patients showing the most favourable prognoses (PS 0-2 and Hb concentration >12.1 g dL(-1) or PS 0-2 and Hb concentration ≤12.1 g dL(-1) without pain), and group B comprised the remaining patients. The median overall survival in groups A and B was 563 days (95 % confidence interval [CI] 502-779) and 157 days (95 % CI 115-224), respectively (hazard ratio of 5.44 [3.46-8.53, P < 0.0001]).
  
  
  CONCLUSIONS
  The MPM patients with PS 0-2 and Hb concentration >12.1 or ≤12.1 g dL(-1) without chest pain had favourable prognoses.
authors.affiliation: Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino Habikino-shi, Osaka, 583-8588, Japan, suzukih@opho.jp.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Asami
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hirashima
authors.forename: Norio
authors.initials: N
authors.lastname: Okamoto
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Yamadori
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tamiya
authors.forename: Naoko
authors.initials: N
authors.lastname: Morishita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiroyama
authors.forename: Sawa
authors.initials: S
authors.lastname: Takeoka
authors.forename: Akio
authors.initials: A
authors.lastname: Osa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Azuma
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Okishio
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Atagi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawase
mesh_terms: D000368:Aged; D000465:Algorithms; D001194:Asbestos / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D003661:Decision Support Techniques; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D000086002:Mesothelioma, Malignant; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010976:Platelet Count; D010997:Pleural Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D001194:Asbestos; D007770:L-Lactate Dehydrogenase