Introduction: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population. Methods: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyõgo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared. Results: Two hundred eighty‐nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5–56.1) months; median age was 63.0 (interquartile range: 57.0–67.8) years, and 83.0% (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p < 0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57–0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center. Conclusions: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM.

中文翻译：

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使用常规临床参数对接受细胞减灭术的恶性胸膜间皮瘤患者的生存进行分层的预测建模

简介：恶性胸膜间皮瘤（MPM）是一种罕见的癌症，预后差且生存期异质性。一些专科中心为精心挑选的患者提供 MPM 手术。先前描述的分类和回归树 (CART) 模型使用常规收集的临床数据对未选择的 MPM 患者的生存进行分层。本研究旨在检查该 CART 模型在高度选择的手术人群中的性能。方法：从 1991 年至 2016 年间在日本 Hyõgo 和澳大利亚悉尼的专科中心接受 MPM 细胞减灭手术的受试者收集数据。 CART 模型应用临床变量组合将受试者分为风险组（1 至4); 然后比较生存特征。结果：包括 289 例（澳大利亚 205 例，日本 84 例）。总体中位生存期为 34.6（四分位距：17.5-56.1）个月；中位年龄为 63.0（四分位距：57.0-67.8）岁，83.0%（n = 240）为男性。两个队列之间没有临床意义的差异。四个风险组的存活率显着不同（p < 0.0001）；该模型在 36 个月时使用 0.62（95% 置信区间：0.57–0.66）的 Harrell 一致性统计对生存进行了很好的分层。存活时间最长的组（中位数为 82.5 个月）：转诊至手术中心时，体重无减轻、血红蛋白 > 153 g/L 和血清白蛋白 > 43 g/L。结论：使用常规可用的临床变量，CART 模型能够将手术患者分为具有统计学差异的生存特征的风险组，并且表现一般到良好。在考虑对 MPM 进行手术治疗时，应谨慎考虑体重减轻、贫血和低白蛋白。