Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery

Edward J. A. Harris, Steven Kao, Brian McCaughan, Takashi Nakano, Nobuyuki Kondo, Rebecca Hyland, Anna K. Nowak, Nicholas H. de Klerk, Fraser J. H. Brims

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population.

Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyogo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared.

Results: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0% (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p <0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center.

Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)288-293
Number of pages6
JournalJournal of Thoracic Oncology
Volume14
Issue number2
DOIs
Publication statusPublished - Feb 2019

Cite this

Harris, Edward J. A. ; Kao, Steven ; McCaughan, Brian ; Nakano, Takashi ; Kondo, Nobuyuki ; Hyland, Rebecca ; Nowak, Anna K. ; de Klerk, Nicholas H. ; Brims, Fraser J. H. / Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery. In: Journal of Thoracic Oncology. 2019 ; Vol. 14, No. 2. pp. 288-293.
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abstract = "Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population.Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyogo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared.Results: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0{\%} (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p <0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95{\%} confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center.Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.",
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Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery. / Harris, Edward J. A.; Kao, Steven; McCaughan, Brian; Nakano, Takashi; Kondo, Nobuyuki; Hyland, Rebecca; Nowak, Anna K.; de Klerk, Nicholas H.; Brims, Fraser J. H.

In: Journal of Thoracic Oncology, Vol. 14, No. 2, 02.2019, p. 288-293.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction modelling using routine clinical parameters to stratify survival in Malignant Pleural Mesothelioma patients undergoing cytoreductive surgery

AU - Harris, Edward J. A.

AU - Kao, Steven

AU - McCaughan, Brian

AU - Nakano, Takashi

AU - Kondo, Nobuyuki

AU - Hyland, Rebecca

AU - Nowak, Anna K.

AU - de Klerk, Nicholas H.

AU - Brims, Fraser J. H.

PY - 2019/2

Y1 - 2019/2

N2 - Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population.Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyogo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared.Results: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0% (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p <0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center.Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

AB - Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population.Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyogo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared.Results: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0% (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p <0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center.Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

KW - Mesothelioma

KW - Prediction modeling

KW - Thoracic surgery

KW - CISPLATIN

KW - PERIOD

U2 - 10.1016/j.jtho.2018.10.005

DO - 10.1016/j.jtho.2018.10.005

M3 - Article

VL - 14

SP - 288

EP - 293

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

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ER -