Chest
Volume 113, Issue 3, March 1998, Pages 723-731
Journal home page for Chest

Clinical Investigations: The Pleura
Factors Predictive of Survival Among 337 Patients With Mesothelioma Treated Between 1984 and 1994 by the Cancer and Leukemia Group B

https://doi.org/10.1378/chest.113.3.723Get rights and content

Purpose

To examine the individual and joint effect of various pretreatment clinical characteristics on the survival of patients with mesothelioma treated by the Cancer and Leukemia Group B (CALGB).

Patients and methods

Between June 1984 and September 1994, 337 patients with malignant mesothelioma and no prior chemotherapy were accrued to seven phase II studies conducted by the CALGB which screened the efficacy of 10 treatment regimens or dose levels. The eligibility criteria for all studies were virtually identical. Patient characteristics include the following: age older than 60 years (63%); male (83%); performance status (PS) of 0 or 1 (81%); chest pain (60%); definite asbestos exposure (62%); >5% weight loss (41%); and pleural involvement (94%). Median survival time (MST) for the 10 treatment regimens ranged from 3.9 to 9.8 months (overall=7.2; 95% confidence interval [CI], 6.5 to 8.3), with 1-year survival between 14% and 50% (overall=27%; 95% CI, 23 to 33%).

Results

Cox survival models and exponential regression trees were used to examine the prognostic importance of pretreatment patient characteristics. Univariate analyses show that patients with poor Eastern Cooperative Oncology Group PS, chest pain, dyspnea, platelet count (PLT) >400, 000/μL, weight loss, serum lactate dehydrogenase (LDH) level >500 IU/L, pleural involvement, low hemoglobin (HGB) level, high WBC count, and increasing age over 75 years have a worse prognosis. With decreasing risk ratio, multivariate Cox analyses showed that pleural involvement, LDH >500 IU/L, poor PS, chest pain, PLT >400, 000/μL, nonepithelial histology, and increasing age older than 75 years jointly predict poor survival. PS was the most important prognostic split in the regression tree. Terminal nodes were amalgamated to form six distinct prognostic subgroups with MST (2-year survival) of 13.9 (38%) in 36 patients, 9.5 (21%) in 36 patients, 9.2 (10%) in 146 patients, 6.5 (3%) in 33 patients, 4.4 (0%) in 73 patients, and 1.4 (0%) in 13 patients (p<0.0001).

Conclusions

The subgroup with the best survival (MST=13.9 months) included patients with PS=0 and age younger than 49 years, and patients with PS=0, age of 49 years or older, and HGB ≧14.6. The worst survival (MST=1.4 months) occurred for patients with PS=1/2 and WBC ≧15.6/μL.

Section snippets

Study Design and Eligibility Criteria

Table 1 summarizes the seven phase II studies for the treatment of mesothelioma that have been conducted by the CALGB between 1984 and 1994. The eligibility criteria for all studies were almost identical and included the following requirements: histologically confirmed malignant mesothelioma with measurable or evaluable disease; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 to 2 (<50% of waking hours in bed); expected survival >2 months; adequate nutrition; no prior

Patient Demographics

The profile of patients with mesothelioma treated on CALGB protocols is summarized in Table 2. Patients were generally male (83%), had good PS (ECOG PS=0 or 1; 81%), presented with chest pain (60%) or dyspnea (70%) after experiencing symptoms for <3 months (46%), had a history of asbestos exposure (62%) or smoking (72%), and had disease involving the pleura (94%). Age ranged from 23 to 83 years, with an average of 61.3 years.

The overall response rate and median survival for each treatment

Discussion

Numerous articles have examined the impact of various clinical factors on the prognosis or survival of patients diagnosed as having mesothelioma. Table 525, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 lists 17 of these articles, along with the time period during which these patient cohorts were diagnosed and the number of patients included in that cohort. The article by Spirtas et al,31 which reported on the largest patient cohort of 1, 475 patients, was based on information

Acknowledgments

Brian Samuels, Chandra Belani, Lisa Weissman, David Harmon, Karen Antman, Joseph Aisner, David Sugarbaker, James Holland, Maurice Barcos, and numerous other individuals within the CALGB contributed in a major way to this 10- to 15-year effort.

References (41)

  • HarmonD et al.

    Dihydro-5-azacytidine in malignant mesothelioma using serum hyaluronic acid as a tumor marker: a phase II trial of the CALGB [abstract 1248]

    Proc Am Soc Clin Oncol

    (1991)
  • VogelzangNJ et al.

    Trimetrexate in malignant mesothelioma: a Cancer and Leukemia Group B phase II study

    J Clin Oncol

    (1994)
  • SamuelsBL et al.

    Dihydro-5-azacytidine (DHAC) and cisplatin (DDP) in malignant mesothelioma [abstract 1470]

    Proc Am Soc Clin Oncol

    (1992)
  • SamuelsBL et al.

    Dihydro-5-azacytidine (DHAC) and cisplatin (DDP) in mesothelioma (CALGB 9031) [abstract 1371]

    Proc Am Soc Clin Oncol

    (1994)
  • BelaniCP et al.

    Edatrexate for malignant mesothelioma: a phase II study of the Cancer and Leukemia Group B (CALGB) [abstract 1087]

    Proc Am Soc Clin Oncol

    (1994)
  • BelaniC et al.

    Edatrexate with oral leucovorin rescue for malignant mesothelioma: a phase II study of the Cancer and Leukemia Group B (CALGB 9131) [abstract 1068]

    Proc Am Soc Clin Oncol

    (1995)
  • VogelzangNJ et al.

    Paclitaxol (Taxol) for malignant mesothelioma (MM): a phase II study of the Cancer and Leukemia Group B (CALGB 9234) [abstract 1382]

    Proc Am Soc Clin Oncol

    (1994)
  • ButchartEG et al.

    Pleuropneu-monectomy in the management of diffuse malignant mesothelioma of the pleura

    Thorax

    (1976)
  • RuschVW

    A proposed new international TNM staging system for malignant pleural mesothelioma: from the International Mesothelioma Interest Group

    Chest

    (1995)
  • KaplanEL et al.

    Nonparametric estimation from incomplete observations

    J Am Stat Assoc

    (1958)
  • Cited by (454)

    • Pleural mesothelioma

      2022, Medicine (Spain)
    • Malignant and borderline mesothelial tumors of the pleura

      2022, Practical Pulmonary Pathology: A Diagnostic Approach
    View all citing articles on Scopus

    Supported by CA33601 (Dr. Herndon), CA31946 (Dr. Green), CA04457 (Drs. Chahinian and Suzuki), and CA41287 (Dr. Vogelzang).

    View full text