title: Prognostic factors in elderly patients with malignant pleural mesothelioma: results of a multicenter survey.
abstract: BACKGROUND
  The incidence of malignant pleural mesothelioma (MPM) in elderly patients is increasing. There are no specific guidelines for their management.
  
  
  METHODS
  The clinical records of elderly patients (⩾70 years old) with MPM referred from January 2005 to November 2011 to six Italian Centres were reviewed. Age, gender, histology, International Mesothelioma Interest Group (IMIG) stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and treatment modalities were analysed and correlated to overall survival (OS).
  
  
  RESULTS
  In total, 241 patients were identified. Charlson Comorbidity Index was ⩾1 in 92 patients (38%). Treatment was multimodality therapy including surgery in 18, chemotherapy alone in 180 (75%) and best supportive care in 43 cases (18%). Chemotherapy was mainly pemetrexed based. Median OS was 11.4 months. Non-epithelioid histology (HR 2.32; 95% CI 1.66-3.23, P<0.001), age ⩾75 years (HR 1.44; 95% CI 1.08-1.93, P=0.014), advanced (III-IV) stage (HR 1.47; 95% CI 1.09-1.98, P=0.011) and CCI⩾1 (HR 1.38; 95% CI 1.02-1.85, P=0.034) were associated to a shorter OS. Treatment with pemetrexed was associated with improved OS (HR 0.40; 95% CI 0.28-0.56, P<0.001).
  
  
  CONCLUSIONS
  Non-epithelioid histology, age ⩾75 years, advanced IMIG stage and presence of comorbidities according to CCI were significant prognostic factors in elderly patients with MPM. Treatment with pemetrexed-based chemotherapy was feasible in this setting. Prospective dedicated trials in MPM elderly patients selected according to prognostic factors including comorbidity scales are warranted.
authors.affiliation: Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Ceresoli
authors.affiliation: Oncology, Ospedale SS Antonio e Biagio, Alessandria, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Grosso
authors.affiliation: Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy.
authors.forename: P A
authors.initials: PA
authors.lastname: Zucali
authors.affiliation: Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mencoboni
authors.affiliation: Oncology, Istituto Oncologico Veneto, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pasello
authors.affiliation: Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ripa
authors.affiliation: Palliative Care Unit, Ospedale S. Spirito, Casale Monferrato, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Degiovanni
authors.affiliation: Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Simonelli
authors.affiliation: Oncology, Ospedale Villa Scassi, Sampierdarena, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bruzzone
authors.affiliation: Epidemiology, ASL Alessandria, Alessandria, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Dipietrantonj
authors.affiliation: Pneumology, Ospedale S. Spirito, Casale Monferrato, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Piccolini
authors.affiliation: Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: G D
authors.initials: GD
authors.lastname: Beretta
authors.affiliation: Oncology, Istituto Oncologico Veneto, Padova, Italy.
authors.forename: A G
authors.initials: AG
authors.lastname: Favaretto
authors.affiliation: Biostatistic Unit, Humanitas Cancer Center, Rozzano (Milan), Italy.
authors.forename: L
authors.initials: L
authors.lastname: Giordano
authors.affiliation: Oncology, Humanitas Cancer Center, Rozzano (Milan), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Oncology, Ospedale S. Spirito, Casale Monferrato, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Botta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000086002:Mesothelioma, Malignant; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome