Skip to content

    Lung Cancer Health Center

    Font Size

    Malignant Mesothelioma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Malignant Mesothelioma Treatment

    Diagnosis and Prognostic Factors

    Prognosis in malignant mesothelioma is difficult to assess consistently because there is great variability in the time before diagnosis and the rate of disease progression. In large retrospective series of pleural mesothelioma patients, important prognostic factors were found to be:[1,2][Level of evidence: 3iiiA]

    Recommended Related to Lung Cancer

    Non-Small-Cell Lung Cancer: Treatment by Stage

    After your lung cancer is diagnosed, the doctor will run tests to find out the size of the tumor and whether the cancer has spread to other parts of the body. This process is called staging. Knowing the stage of your disease is crucial because it will help you and your doctor choose the best course of treatment. Here’s a look at the options for each stage. Keep in mind that no one can say for sure how your cancer will respond. Every person is different, and so is every cancer. Your doctor will make...

    Read the Non-Small-Cell Lung Cancer: Treatment by Stage article > >

    • Stage.
    • Age.
    • Performance status.
    • Histology.

    Prognostic Scoring Systems

    Two prognostic scoring systems have been developed for advanced unresectable mesothelioma and are used to stratify patients enrolling in clinical trials: the Cancer and Leukemia Group B (CALGB) index and the European Organization for the Research and Treatment of Cancer (EORTC) index.

    CALGB index

    The CALGB index was developed retrospectively using the clinical characteristics of 337 patients treated on clinical trials of chemotherapy for advanced mesothelioma during a 10-year period.[3][Level of evidence: 3iiiA] These characteristics were used collectively to define six prognostic groups with median survivals ranging from 13.9 months (Eastern Cooperative Oncology Group [ECOG] performance status [PS] = 0, age <49 years; or PS = 0, age ≥49 years and hemoglobin ≥14.6g/dL) to 1.4 months (PS = 1 or 2 and white blood cell [WBC] count ≥15.6 × 109/L).

    The prognostic value of the CALGB index was evaluated retrospectively in a phase II clinical trial of 105 patients.[4][Level of evidence: 3iii] Median survival in this study for patients in the best CALBG prognostic group was 29.9 months compared with 1.8 months for patients in the worst prognostic group. However, the intermediate groups 2 to 4 overlapped in their survival times.

    EORTC index

    The EORTC index was also developed retrospectively using the characteristics of 181 patients from five phase II clinical trials of chemotherapy during a 9-year period.[5][Level of evidence: 3iiiA] In a multivariate analysis, the following characteristics were associated with poorer survival:

    • WBC count >8.3 × 109/L.
    • ECOG PS ≥1.
    • Unconfirmed histology on central review.
    • Nonepithelioid histology.
    • Male gender.

    Patients were allocated a numerical prognostic score based on each of these variables (+0.55 if WBC >8.3 × 109/L, +0.60 if ECOG PS ≥1, +0.52 if unconfirmed histology, and +0.60 if male gender). Subsequently, patients were classified into two prognostic groups that included low-risk patients with a prognostic score of ≤1.27 (0-2 risk factors) and high-risk patients with a prognostic score of >1.27 (3-5 risk factors). High-risk patients had a relative risk of death of 2.9 compared with low-risk patients, P < .001; the 1-year survival rate was 40% for the low-risk group compared with 12% for the high-risk group.

    1 | 2
    Next Article:

    Today on WebMD

    Xray analysis
    Do you know the myths from the facts?
    chest x-ray
    Get to know them.
    woman taking pills
    Tips to managing them.
    Lung cancer xray
    See it in pictures, plus read the facts.
    Lung Cancer Risks Myths and Facts
    Woman getting ct scan
    Improving Lung Cancer Survival Targeted Therapy
    cancer fighting foods
    Lung Cancer Surprising Differences Between Sexes
    Pets Improve Your Health
    Vitamin D
    Lung Cancer Surgery Options