The new study done by Chinese researchers at the Peking University, newly formulated visual prediction tool, nomogram, can give better predictions about the survival of pleural mesothelioma patients after undergoing surgery.

With the use of this incredibly reliable tool, surgeons will be able to benefit the patients greatly by making individualized predictions and optimizing the most favorable treatment following all the data available. Moreover, it will help in further clinical research on the prognosis of cancer.

The Chinese researchers proposed that currently using the technique to check the overall survival of the patients, TNM staging, can be replaced by a visually much better predicting too, nomogram. This conclusion, based on thorough research considered several factors affecting the prognosis such as age, lymph node status, and histology.

This study covered a broad spectrum of data taken from SEER- the United States National Cancer Institute Surveillance, Epidemiology, and End Results database. The data of a total of 1140 patients were analyzed which were diagnosed with the malignant pleural mesothelioma in a decade, from 2004 to 2014.

Through experimental results, the author of the research report wrote,

The nomogram showed good discriminative ability and was well-calibrated. These results improve our understanding of resected MPM lesions and provide a reliable tool for predicting patient OS.

The significance of the TNM Staging System in Predicting Pleural Mesothelioma Survival

Pleural mesothelioma is the most common type of mesothelioma cancer caused mainly by inhaling asbestos fibers, affecting the lining of the lungs and chest wall. About 75% of the mesothelioma diagnosed patients suffer through malignant pleural mesothelioma. Among other cancer staging techniques, TNM staging the most commonly used method for measuring pleural mesothelioma staging.

Cancer staging refers to the process of evaluating the malignancy of cancer by configuring its location and the severity of its spread to the adjoining areas. TNM staging is the most commonly used cancer staging system that refers to the seriousness of Tumor (T), the number of affected adjacent lymph nodes (N), and the occurrence of Metastasis (M).

With the TNM staging technique, higher the TNM value, more extensive will be the spread of mesothelioma cancer in the body. A few scientific pieces of research have shown that a higher TNM stage predicts poor survival of the pleural mesothelioma patients.

But the Chinese researchers have nullified the proficiency of TNM staging in predicting the survival of pleural mesothelioma patients, as written in the research report,

“It has been reported that  TNM staging is related to MPM (malignant Pleural mesothelioma) prognosis. However, we found no significant association between OS (Overall Survival) and TNM staging.”

Validation of the Nomogram through Extensive Experimental Design

The researcher’s team chose the most extensive, and comprehensive database to design their experiment, thus confirming the reliability and authenticity of the final results.

The SEER (Surveillance, Epidemiology, and End Results) database is a division of the National Cancer Institute that provides authoritative information about the cancer statistics to the scientists from all over the world. There is an extensive and authenticated data available all types of cancers displaying the actual number, and percentage of estimated ages of a new diagnosis, the prevalence of the disease in the country and several other specific facts.

A total of 4372 patients diagnosed with malignant pleural mesothelioma. Before making the final pick, the researchers analyzed only the patients with survival data available in the record and patients who had gone through cancer-directed surgery.

The researchers retrieved the data of 828 pleural mesothelioma patients diagnosed between 2004-2011 to construct the nomogram. Then to validate the results, researchers analyzed the data of another 312 patients diagnosed with pleural mesothelioma between 2012-2014 with the actual data from the database.

Through the analysis of the visual chart created, and validation of the results with a separate group of 312 patients, the researchers concluded the prominent accuracy and efficiency of the predictions made by the nomogram, saying,

“A calibration plot for the nomogram for predicting one‐year and three‐year survival indicated that the nomogram has high predictive accuracy in the validation cohort,”

Factors Affecting the Survival Rate of Mesothelioma Patients After Surgery

The researchers have comprehensively discussed significant factors that impact the survival of pleural mesothelioma patients after surgery, including cancer stage, subtype, chemotherapy, type of surgery (NOS or Palliative), nodal status, age, and gender.

The results devised through the nanogram in this research were consistent with previous research in terms of analyzing the effect of the factors mentioned above in the survival of pleural mesothelioma patients.

Such as there are more chances of improved survival in younger patients aged 70 years or above than the patients aged 80 years or above.

Here, the researchers validated it through nomogram, saying, "Our nomogram also showed that the mortality risk rises sharply with the increase in age in patients aged > 70."

Another research published in 2014 by the researchers at the North Shore/Long Island Jewish Health System-Hofstra School of Medicine showed that female patients have more chances of survival than the male malignant pleural mesothelioma patients. However, further clinical research will be required to confirm the survival rate.

Overall, this research can be tremendously helpful for much better planning of surgical treatments at the individual level. By creating an exclusive visual nomogram for each pleural mesothelioma patient individually, the surgeons can accurately predict the mesothelioma prognosis and thus can devise a personalized plan for further surgical treatment.

“The nomogram is a reliable tool that can help clinicians turn individualized prediction into reality and maximize the patient benefit by identifying the most beneficial treatment approach.”

In the future, the researchers are planning to thoroughly conduct separate research in devising a new nomogram, accurately analyzing those pleural mesothelioma patients who do not undergo surgery, thus predicting their survival probability.

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