Survival analysis via nomogram of surgical patients with malignant pleural mesothelioma in the Surveillance, Epidemiology, and End Results database

Thorac Cancer. 2019 May;10(5):1193-1202. doi: 10.1111/1759-7714.13063. Epub 2019 Apr 5.


Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor that originates from the pleura and has a poor prognosis. Eligible patients can benefit from surgery, but their survival is affected by many factors. Therefore, we created a graphic model that could predict the prognosis of surgically treated patients.

Methods: We retrospectively analyzed data from the Surveillance, Epidemiology, and End Results database from 2004 to 2014 to identify the key factors affecting the prognosis of surgically treated MPM patients. On this basis we built a nomogram to predict survival. We then evaluated the performance of the nomogram in a validation cohort.

Results: In a training cohort of 828 cases, independent prognostic factors, including age, gender, histological type, differentiation, N stage, chemotherapy, type of surgery, and lymph node dissection, were identified. We then developed a nomogram to evaluate individual patient survival. In Kaplan-Meier analysis, a higher score in the nomogram was associated with a worse prognosis. We also used a validation cohort consisting of 312 patients to evaluate the performance of the nomogram, which was well calibrated and had good discrimination ability, with concordance indices of 0.715 and 0.656 for the training and validation cohorts, respectively.

Conclusion: This study has improved our understanding of resected MPM and shown that key factors, including age and histological type, are associated with overall survival. The nomogram is a reliable tool that can help clinicians turn individualized prediction into reality and maximize patient benefit by identifying the most beneficial treatment approach.

Keywords: Malignant pleural mesothelioma; SEER; nomogram; surgery; survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / surgery
  • Male
  • Mesothelioma / diagnosis
  • Mesothelioma / epidemiology
  • Mesothelioma / mortality*
  • Mesothelioma / surgery
  • Mesothelioma, Malignant
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Staging
  • Nomograms
  • Pleural Neoplasms / diagnosis
  • Pleural Neoplasms / epidemiology
  • Pleural Neoplasms / mortality*
  • Pleural Neoplasms / surgery
  • SEER Program