Zentralbl Chir 2016; 141 - FV45
DOI: 10.1055/s-0036-1587540

A New Prognostic Score for Treatment Allocation for Multimodality Therapy for Malignant Pleural Mesothelioma – An Update

I Opitz 1, M Friess 1, O Lauk 1, T Frauenfelder 2, TDL Ngyuyen 2, I Inci 1, S Hillinger 1, D Schneiter 1, B Seifert 3, R Stahel 4, W Weder 1
  • 1Klinik für Thoraxchirurgie, Universitätsspital Zürich
  • 2Department of Diagnostic Radiology, Universitätsspital Zürich
  • 3Institut für Epidemiologie, Biostatistik und Prävention, Universitätsspital Zürich
  • 4Klinik für Onkologie, Universitätsspital Zürich

Hintergrund: We developed a Multimodality Prognostic Score (MMPS) in our patient cohort receiving induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) to facilitate the decision for surgery after induction chemotherapy.

Material und Methode: A 4 variable MMPS was developed including pre-chemotherapy tumor volume (> 500 ml), progressive disease (PD) after induction chemotherapy (according to modified RECIST criteria), pre-chemotherapy CRP (> 30 mg/ml) and non-epithelioid histological subtype. Overall survival (OS) was calculated from the first cycle of induction chemotherapy until death, and association with the score was analyzed using Kaplan-Meier curve and log rank test.

Ergebnis: Between 1999 and 2015, 253 patients were intended to be treated with induction chemotherapy plus EPP. In 63 undergoing EPP and 20 undergoing pleurectomy/decortication (P/D) all variables of MMPS were available. Median age at diagnosis was 61 years in the EPP group and 65 in the P/D group. Epithelioid type was diagnosed in 81% of the EPP and 95% of the P/D group. IMIG stage III in EPP group was 63% and 65% in the P/D group.

In the EPP cohort patients with score 0 survived significantly longer than patients with score 3 or higher. The median OS for patients of the EPP cohort was 34 months (95% CI, 18 – 50) for score 0, 15 months (9 – 21) for score 1, 12 months (8 – 16) for score 2 and 4 months (3 – 6) for score 3 and 4. In the P/D group the maximum score reached was 2 in only one patient. All the others had a score of 0 or 1. The median OS for score 1 was 30 months (95%CI: 25 – 36) and 17 months for score 2, but 70% percent of the cases were censored.

Schlussfolgerung: Our Multimodality Prognostic Score considering clinical variables already available before surgery allows identification of mesothelioma patients who would not get any relevant benefit from an intensified therapy. The concept is currently under prospective evaluation.