title: Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales.
abstract: BACKGROUND
  Although the prognosis of most patients presenting with malignant pleural mesothelioma (MPM) is poor, a small proportion survives long term. We investigated factors associated with survival in a large patient series.
  
  
  METHODS
  All patients registered with the NSW Dust Diseases Board (2002-2009) were included in an analysis of prognostic factors using Kaplan-Meier and Cox regression analysis. On the basis of these analyses, we developed a risk score (Prognostic Index (PI)).
  
  
  RESULTS
  We identified 910 patients: 90% male; histology (epithelioid 60%; biphasic 13%; sarcomatoid 17%); stage (Tx-I-II 48%; III-IV 52%); and calretinin expression (91%).
  
  
  METHODS
  chemotherapy(CT) 44%, and extrapleural-pneumonectomy (EPP) 6%. Median overall survival (OS) was 10.0 months. Longer OS was associated with: age <70 (13.5 vs 8.5 months; P<0.001); female gender (12.0 vs 9.9 months; P<0.001); epithelioid subtype (13.3 vs 6.2 months; P<0.001); ECOG status 0 (27.4 vs 9.7 months; P=0.015), calretinin expression (10.9 vs 5.5 months; P<0.001); neutrophil-lymphocyte ratio (NLR) <5 (11.9 vs 7.5 months; P<0.001); platelet count <400 (11.5 vs 7.2 months; P<0.001); and normal haemoglobin (16.4 vs 8.8 months; P<0.001). On time-dependent analysis, patients receiving pemetrexed-based chemotherapy (HR=0.83; P=0.048) or EPP (HR=0.41; P<0.001) had improved survival. Age, gender, histology, calretinin and haematological factors remained significant on multivariate analysis. In all, 24% of patients survived >20 months: 16% of these receiving EPP, and 66% CT. The PI offered improved prognostic discrimination over one of the existing prognostic models (EORTC).
  
  
  CONCLUSIONS
  We identified calretinin expression, age, gender, histological subtype, platelet count and haemoglobin level as independent prognostic factors. Patients undergoing EPP or pemetrexed-based chemotherapy demonstrated better survival, but 84% and 34% of long survivors, respectively, did not receive radical surgery or chemotherapy.
authors.affiliation: 1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Concord Cancer Centre, Sydney, Concord, NSW 2139, Australia [3] Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Linton
authors.affiliation: 1] Sydney Medical School, University of Sydney, Sydney, Australia [2] Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Pavlakis
authors.affiliation: 1] NHMRC Clinical Trials Centre, Camperdown, NSW 2050, Australia [2] Sydney Cancer Centre, Camperdown, NSW 2050, Australia.
authors.forename: R
authors.initials: R
authors.lastname: O'Connell
authors.affiliation: 1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia [3] Cancer Institute NSW, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Soeberg
authors.affiliation: 1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kao
authors.affiliation: 1] Sydney Medical School, University of Sydney, Sydney, Australia [2] Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Clarke
authors.affiliation: 1] Concord Cancer Centre, Sydney, Concord, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Vardy
authors.affiliation: 1] Asbestos Diseases Research Institute (ADRI), University of Sydney, PO Box 3628, Rhodes, NSW 2139, Australia [2] Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: N
authors.initials: N
authors.lastname: van Zandwijk
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology; D009517:New South Wales; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate