Introduction Malignant pleural mesothelioma (MPM) has a poor, but heterogeneous prognosis. Previously developed prognostic scores have been derived from patient cohorts not typical of routine UK practice. Recently, a novel prognostic tool, validated in unselected UK patients was published.1
Objective To evaluate the utility of a novel prediction model by Brims et al,1 to predict prognosis in mesothelioma patients presenting to a two-site UK district general hospital.
Methods Consecutive patients diagnosed with mesothelioma between January 2010 and December 2015 were identified. Data were collected from electronic records at diagnosis (age, gender, histology, performance score, haemoglobin, albumin, weight loss) as well as dates of diagnosis and of death or last follow-up. Patients were allocated to prognostic groups as described by Brims et al. Groups were compared using Kaplan-Meier survival analysis. The proportion of patients whose survival fell within ± 33% of the survival predicted from the validation cohort of Brims et al. was calculated.
Results 71 patients (60 male) were diagnosed with MPM during the study period, median age 74 (interquartile range (IQR) 15). Histological diagnosis was available in 66 (93%) patients (43.9% epithelioid, 21.2% undefined mesothelioma, 18.2% sarcomatoid, 13.6% biphasic, 3.0% atypical/mixed). Median overall survival was 262 days (IQR 284 days). 97% of patients could be allocated to a prognostic group. Median survival by Brims group, compared with predicted survival, is shown in Table 1.
Conclusions The “Brims Score” can be retrospectively calculated in a high proportion of patients, using routinely collected data. It appears reliably to separate patients into cohorts with statistically significant difference in survival. The large within-group variation in survival, however, limits the utility of the score as a means of answering the question, “How long have I got, doc?” for individual patients.
Brims F, Meniawy T, Duffus I, et al. A novel clinical prediction model for prognosis in malignant pleural mesothelioma using decision tree analysis. Journal of Thoracic Oncology 2016;11(4);573–582.