Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
1 Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong/
China, 2 University of Minnesota, Minneapolis/MN/United States of America,
3 Duke University Medical Center, Durham/United States of America, 4 Section of
Hematology/Oncology, University of Chicago, Chicago/IL/United States of America,
5 Section of Hematology/Oncology, University of Chicago, Chicago/United States of
America
Background: Prognostic models play an important role in the design and
analysis of mesothelioma treatment trials. The European Organisation for
Research and Treatment of Cancer (EORTC) developed a well-known tool in
1998 to predict overall survival (OS) in patients with malignant mesothelioma.
In this study, we built and assessed the performance of a new mesothelioma
prognostic model OS using data from multiple CALGB clinical trials data.
Methods: This study included 595 mesothelioma patients from fifteen
completed CALGB treatment trials accrued between June 1984 and August
2009. We split the cohort of patients into two parts - 67% of patients as
training and 33% as testing. We developed a Cox model using the training
set with PS, age, WBC count, and platelet count as prognostic variables.
To compare the EORTC and our new models, the concordance of predicted
survival times and risk scores were estimated by concordance C (c-index)
(Harrell et al. 1996) and AUC score at 6-months (Patrick et al. 2000). 95%
confidence intervals were calculated for the c-index. Based on the prediction
model fit from training set, we partitioned testing set patients into high-risk
and low-risk groups using the median for their risk score values for the new
model. For the EORTC model, the cut off of 1.27 from the original paper was
used to assign the high-risk and low-risk groups. A Log-rank test was used
to compare the survival curves of these two groups. We also compared our
results with a model using PS alone. Results: For OS, the EORTC model c-index
was 0.55 (0.52, 0.58) and P = 0.0007 comparing high- and low- risk patients for
testing set. The new model c-index was 0.60 (0.56, 0.64), with P < 0.000001 for
testing set. Using the new model, the median OS in the high-risk and low-risk
groups in the testing set were 5.16 (4.70, 6.37) and 10.41 (7.95, 14.32) months,
respectively. PS alone produced c-index of 0.55 (0.53, 0.57) and P = 0.0002
for testing set. The AUC scores at 6-months for testing set generated by
EORTC and PS alone models are 0.62 and 0.66. The new model generated AUC
scores at 6-months of 0.70. Conclusion: Our new model performs better than
the EORTC model or PS alone for survival prognostication in patients with
mesothelioma.
Keywords: clinical trials, prognostic model, Mesothelioma
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-037 IMPACT OF SARCOMATOID COMPONENT IN PATIENTS
WITH BIPHASIC MESOTHELIOMA: REVIEW OF 118 PATIENTS
Andrea Bille 1 , Styliani Maria Kolokotroni 1 , Juliet King 1 , Jeremy Smelt 1 , Leanne
Ashrafian 1 , James Spicer 2 , Tom Routledge 1 , Wen Ng 3
1 Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London/United
Kingdom, 2 Division of Cancer Studies, Guy’s and St Thomas’ NHS Foundation Trust,
London/United Kingdom, 3 Histopathology, Guy’s and St Thomas’ NHS Foundation
Trust, London/United Kingdom
Background: Biphasic mesothelioma has a poor prognosis. There is no
clear evidence on the role of multimodality treatment in patients with
biphasic mesothelioma. The aim of this study was to analyse the impact of
pathological features on survival, to determine which patients may benefit
from multimodality treatment. Methods: Between January 2005 and
December 2015, 214 patients with biopsy-proven biphasic mesothelioma were
retrospectively identified to fulfil our inclusion criteria. The primary outcome
was survival measured from time of diagnosis. Two slides were reviewed for
each patient by a specialist thoracic pathologist. Slides were stained with
Hematoxylin and Eosin (H+E) and the immunohistochemically-stained slides
were digitally scanned and analysed using a Hamamatsu Nanozoomer scanner
(Hamamatsu ‘NDP.View2’). The proportion of epithelioid and sarcomatoid
components on each slide was mapped and its area in mm 2 recorded as a
percentage of the total tumour area studied. Necrosis and lymphovascular
invasion were analyzed. Patients with no slides available were excluded
from the analysis (n=96). All eligible patients (n=118) were followed up until
May 2016. Results: One hundred and eighteen patients were included in
the analysis, 106 (89.9%) were male with a median age of 73 (range 53 - 91).
Twenty-eight patients (23.7%) underwent Pleurectomy Decortication (PD)
and 90 patients received medical treatment alone, either with chemotherapy
or best supportive care. The median overall survival (OS) was 11.2 months
(range 0.3 – 36.2). At 1 year and 2 years, 49.1% and 6.4% of patients were alive
respectively. Univariable analysis revealed both age and PD to be associated
with improved survival (p=0.004 and p=0.004). Patients treated with PD had
OS of 12.8 months (range 5.6 - 36), compared to 9.2 months (range 0.3 – 31.8)
in patients receiving medical treatment alone. No lymphovascular invasion
was identified in any specimen. Necrosis was not correlated with survival
(p=0.76). The proportion of epithelioid (p=0.45) or sarcomatoid (p=0.60)
component within the specimen did not correlate significantly with overall
survival. This remained true when patients undergoing surgical PD (epitheloid
p=0.42 and sarcomatoid p=0.60) and medical treatment (epitheloid p=0.43
and sarcomatoid p=0.11) were analysed as separate subgroups. Conclusion:
The prognosis for patients with biphasic mesothelioma remains poor, even
after multimodality treatment including pleurectomy decortication (PD).
However, necrosis and the proportion of sarcomatoid histology is not helpful
in selecting patients with more favourable prognosis, who may benefit from a
multimodality approach.
Keywords: biphasic mesothelioma, sarcomatoid component, survival
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-038 IMPROVING QUALITY OF CARE AND OUTCOMES FOR
PATIENTS DIAGNOSED WITH PLEURAL MESOTHELIOMA IN
ENGLAND
Susan Harden 1 , Paul Beckett 1 , Aamir Khakwani 2 , Rosie Dickinson 1 , Natasha
Wood 3 , Doug West 4 , Neal Navani 1 , Richard Hubbard 2 , Ian Woolhouse 1
1 Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London,
London/United Kingdom, 2 Department of Epidemiology and Public Health,
University of Nottingham, Nottingham/United Kingdom, 3 National Cancer
Registration and Analysis Service, Public Health England, London/United Kingdom,
4 University Hospitals Bristol NHS Foundation Trust, Bristol/United Kingdom
Background: Mesothelioma data has been collected by the National Lung
Cancer Audit (NLCA) since it was introduced in 2004 to improve standards
of care for patients in the UK and ultimately improve outcomes. The first
mesothelioma-specific report combining data submitted to the audit from
2008-2012 was reported in 2014, capturing approximately 85 per cent of
total incident mesothelioma cases. This same year, the NLCA switched from
using a bespoke dataset to use the generic Cancer Outcomes and Services
Dataset (COSD), linked to other National Cancer Registration and Analysis
Service (NCRAS) registry datasets, as its primary data source. This dataset
change has allowed data for all mesothelioma cases diagnosed during 2014, in
England, to be analysed for the first time and reported here. Methods: Using
2014 COSD data submitted to the NLCA for all hospital trusts in England, we
have analysed demographic, diagnostic and active treatment data items and
in particular, have calculated the proportion of cases receiving histological
subtype confirmation, palliative chemotherapy and per cent surviving to
one year after diagnosis, both nationally and by strategic cancer network
(SCN). Results: There were 2179 cases of pleural mesothelioma diagnosed
in England in 2014. Histological confirmation of diagnosis was very high,
but the proportion of mesothelioma cases without histological subclassification
(M9050/3) was 47%. This unspecified mesothelioma rate varied
from 32.6 up to 74.4% by cancer network across England. Overall, palliative
chemotherapy was given to 51% of patients with performance status (PS)
0-1, however at network level, this varied from 42.2% up to 77.4%. For all
cases of mesothelioma, the 1 year overall survival was 43% with variation by
network from 37.5 to 55.6% with adjusted odds ratios (OR) ranging from OR
0.8 up to 1.56. Conclusion: There has been improvement in the proportion of
mesothelioma patients in England receiving histological subtyping compared
to previous years and in the proportion of patients with good PS being treated
with palliative chemotherapy. However, there is still marked variation across
the country and addressing this may improve national outcomes further.
Cancer networks and individual hospitals should examine their results and
implement mechanisms to ensure best practice is being followed.
Keywords: Mesothelioma
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-039 PROGNOSTIC BIOMARKERS FOR MALIGNANT PLEURAL
MESOTHELIOMA TREATED WITH CHEMOTHERAPY
Hakan Akgun 1 , Selma Metintas 2 , Guntulu Ak 3 , Secil Demirkol 4 , Resat Aydın 5 ,
Murat Isbilen 4 , Ali Gure 4 , Muzaffer Metintas 3
1 Medical Faculty Department of Chest Diseases, Eskisehir Osmangazi University,
Eskisehir/Turkey, 2 Lung and Pleural Cancers Research and Clinical Center; Medical
Faculty Department of Public Health, Eskisehir Osmangazi University, Eskisehir/
Turkey, 3 Lung and Pleural Cancers Research and Clinical Center; Medical Faculty
Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir/
Turkey, 4 Department of Molecular Biology and Genetics, Ihsan Dogramacı Bilkent
S718 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017