Prospective validation and extension of the Multimodality Prognostic Score for the treatment allocation of pleural mesothelioma patients

Abstract OBJECTIVES Patient allocation to multimodality treatment in patients with malignant pleural mesothelioma remains a challenge. The aim of this study was to validate our previously established Multimodality Prognostic Score (MMPS) (tumour volume before chemotherapy, histological subtype, C-reactive protein before chemotherapy and tumour progression after chemotherapy) and to extend the score with additional blood parameters for better patient outcome. METHODS Patients with histologically proven malignant pleural mesothelioma and curative intended therapy with clinical stage T1–T3 N0–N2 M0 were eligible. The existing MMPS was validated and further additional blood markers (erythrocytes, neutrophils, monocytes, albumin, gamma-glutamyl transferase and alkaline phosphatase) were evaluated for potential incorporation. RESULTS For the validation of the existing MMPS, as the first part of this analysis, 117 patients treated as of September 2011 were included. A total of 88 patients were treated with macroscopic complete resection, whereas 29 patients were treated with palliative or no surgery. Patients treated with macroscopic complete resection and a high MMPS showed statistically significant lower overall survival. In the second part, the extension of the MMPS with additional blood parameters was analysed. Albumin, the only parameter showing evidence for having influence on overall survival, was further added to the extended MMPS. When comparing the performance measures Area under the curve (AUC) and Brier score, the extended score performed better (higher AUC, lower Brier score) than the original MMPS. CONCLUSIONS The extended score with albumin showed improved performance in comparison to the original score. The extended MMPS also may help allocating patients to surgery. Patient selection, according to the latest ERS/ESTS/EACTS/ESTRO (European Respiratory Society/European Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery/European Society for Radiotherapy and Oncology) guidelines [1], for an optimal therapy approach, remains difficult considering the limited life expectancy of malignant pleural mesothelioma (MPM) patients and the aggressive treatment.