Herndon et al identified risk factors associated with a poor prognosis in patients with malignant mesothelioma using multivariate analysis. This can help identify patients who may be candidates for more aggressive treatment. The authors are from the Cancer and Leukemia Group B (CALGB) representing multiple university hospitals in the United States.
Patient selection: Malignant mesothelioma with an ECOG performance scale of 0 to 2.
Parameters:
(1) pleural involvement
(2) serum LDH
(3) ECOG performance scale
(4) chest pain
(5) platelet count
(6) histologic pattern of the mesothelioma
(7) age of the patient in years
|
Parameters |
Finding |
Points |
|
pleural involvement |
absent |
0 |
|
|
present |
1 |
|
serum LDH |
<= 500 IU/L |
0 |
|
|
> 500 IU/L |
1 |
|
ECOG performance scale |
0 or 1 |
0 |
|
|
2 |
1 |
|
chest pain |
absent |
0 |
|
|
present |
1 |
|
platelet count |
<= 400,000 per µL |
0 |
|
|
> 400,000 per µL |
1 |
|
histology |
epithelial |
0 |
|
|
nonepithelial (sarcomatous) |
1 |
|
age of the patient |
<= 75 years of age |
0 |
|
|
> 75 years of age |
1 |
where:
• In the text on page 726 an ECOG of 1 is considered good. The survival listed on page 726 is 10.9 months with ECOG 0, 7.6 for ECOG 1 and 3.3 for ECOG 2.
total number of poor prognostic factors =
= SUM(points for all 7 parameters)
Interpretation:
• minimum number of poor prognostic factors: 0
• maximum number of poor prognostic factors: 7
• The higher the number of poor prognostic factors the worse the prognosis.
Limitations:
• The methods and normal reference ranges for LDH were not available to the authors (page 725) so a value > 500 IU/L was made on "statistical" grounds.
Specialty: Hematology Oncology, Surgery, general, Pulmonology
