THORAC (Thoracic Cancer Journal) is dedicated to publishing clinical and experimental research in the field of thoracic oncology. As the official journal of the Portuguese Lung Cancer Study Group (Grupo de Estudos de Cancro do Pulmão - GECP), it serves as a vital platform for advancing knowledge and fostering collaboration within the thoracic oncology community.
Grupo de Estudos de Cancro do Pulmão (GECP)
First-Line Lung Cancer Combinations: Are We Treating Better, or Simply Adding Drugs?
Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
Comparison of Receptor Profiles Between Primary Tumors and Isolated Thoracic Metastasesin Breast Cancer
Introduction: Receptor status may change during metastatic progression, potentially altering therapeutic decisions and outcomes. This study aimed to determine ER, PR, and HER2 changes in thoracic metastases (pleura, lung, lymph node, pericardium, chest wall) of breast cancer and to evaluate their impact on survival. Methods: Data of 46 women who underwent an interventional procedure for thoracic metastasis of breast cancer and had available ER/PR/HER2 assessment in both primary and corresponding metastatic tissues were retrospectively analyzed. Post-metastasis survival was calculated from the date of histopathological confirmation of metastatic disease. The associations of primary breast cancer receptor status, metastatic receptor status, and receptor conversion at metastasis with survival outcomes were investigated. Results: The pleura was the most common metastatic site (54.3%). In primary tumors, ER, PR, and HER2 positivity rates were 87%, 63%, and 21%, respectively, whereas in metastatic tissues they were 69.6%, 45.7%, and 25.6%. ER loss was observed in 17.4% of cases, with no gain detected. PR loss occurred in 23.9% and gain in 6.5%, while HER2 loss and gain were observed in 7.0% and 11.6% of cases, respectively. Univariate analysis identified pleural metastasis (HR=3.442, p=0.017), ER negativity in metastatic tissue (HR=3.306, p=0.008), PR negativity in metastatic tissue (HR=2.793, p=0.037), and ER loss (HR=3.095, p=0.022) as adverse prognostic factors. In multivariate analysis, pleural metastasis (HR=4.424, p=0.009) and ER loss (HR=3.669, p=0.010) remained independent predictors of poor survival. No significant association was found between HER2 status and survival. Conclusion: ER loss and pleural metastasis are independent adverse prognostic factors in thoracic metastases of breast cancer. These findings related to tumor biology, particularly receptor status changes between primary and metastatic tumors, may help guide personalized therapeutic approaches.
Lung Cancer and Immunotherapy: When the Immune System Becomes the New Challenge
Pembrolizumab is an immune checkpoint inhibitor. With the introduction of this therapeutic class, the adverse- event profile of antineoplastic therapy has changed, creating new challenges in the longitudinal management of patients with cancer. We report the case of a 75- year- old man with metastatic lung adenocarcinoma (PD- L1 expression 90%90% KRAS G12C mutation) who started treatment with pembrolizumab 2mg/kg2mg/kg every three weeks. Nine months later, he presented with acute hyperglycemia (939 mg/dL) without ketoacidosis, interpreted as autoimmune diabetes secondary to immunotherapy, requiring intensive insulin therapy. Subsequently, he developed bilateral immune- mediated keratitis, treated with artificial tears, topical corticosteroids and antibiotics, as well as systemic corticosteroids. After clinical stabilization, Pembrolizumab therapy was reinstated, with adequate glycemic control and controlled ocular symptoms. This case illustrates multisystem immune- mediated adverse reactions associated with pembrolizumab and the importance of multidisciplinary management for the success of cancer therapy and improvement of patients' quality of life.
Carcinoma, Non-Small-Cell Lung/drug therapy
Drug-Related Side Effects and Adverse Reactions
Immune Checkpoint Inhibitors/adverse effects
Real-World Treatment Pathways in Stage III Non-Small-Cell Lung Cancer Surgical Patients in Portugal
Introduction: Stage III non-small-cell lung cancer (NSCLC) is a complex and heterogeneous disease, with no established optimal treatment sequence. We aimed to characterize surgically treated patients with stage III NSCLC in Portugal. Methods: PICTuRE was a multicentric, retrospective study. Adults with stage III NSCLC diagnosed in 2018 were followed until disease progression, death, loss of follow-up, or end of study. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. Results: Of 278 patients included in PICTuRE, 59 (21.2%) underwent surgery. Surgical patients had a mean age of 65±9 years and were predominantly men (57.6%) and current/former smokers (79.3%). Most presented with adenocarcinoma (71.2%) and stage IIIA disease (79.7%), with ECOG 0-1. All patients underwent at least one non-invasive staging method, while 64.4% received minimally invasive/invasive staging. Lag-times from multidisciplinary team decision to surgery ranged from approximately 1 to 11 months. Neoadjuvant treatment was administered to 22 patients. Resection margins were available for 50 patients (84% R0; 16% R1/R2). Operative mortality and morbidity rates were 3.4% and 25.5%, respectively. Adjuvant treatment was administered to 87.7% of patients, primarily chemoradiotherapy (50%). Median disease-free survival was 22 months, while overall survival was not reached. Conclusion: The real-world analysis of the surgical population in the Portuguese PICTuRE study highlights the complexity and heterogeneity of stage III NSCLC, as well as the ongoing challenges in disease management. Although some recommendations and algorithms for tumour staging exist, practices are not yet consensual, particularly for N2 patients, with few undergoing minimally invasive or invasive methods. No single optimal treatment strategy exists due to variability in tumour extension and nodal involvement; nonetheless, multimodality treatment, including neoadjuvant therapy followed by surgery and adjuvant therapy, may potentially improve survival outcomes. Optimal therapeutic strategy requires careful balancing of patient characteristics, treatment effectiveness and safety within an MDT in a timely process (i.e., reduced delays between diagnosis, staging and treatment initiation). This approach may ensure the delivery of tailored approaches and optimize outcomes for this population. Further studies should evaluate the impact of novel therapies, such as immunotherapy, on treatment patterns and patient outcomes in real-world settings.
Rethinking Lung Cancer Through Screening, Early Detection and Precision Oncology
Testicular Metastasis as a Sanctuary Site Detected on 18F-FDG PET-CT in Disseminated Small-Cell Lung Cancer: A Diagnostic and Management Dilemma
Testicular involvement in the systemic disease is rarely encountered owing to its blood- testis barrier (BTB), making it an immune- privileged site as well as a sanctuary site. Metastasis to the testis from small- cell lung cancer (SCLC) is a rare phenomenon, typically indicating advanced systemic disease and breakdown of the BTB. We present the case of a 64- year- old male with left- sided small- cell lung cancer who underwent 18F- FDG PET- CT for staging. Staging 18F- FDG PET- CT revealed widespread nodal & skeletal metastases and an incidental hypermetabolic focus in the left testis, which was confirmed to be metastatic on HPE. This case highlights the importance of evaluating the scrotum in patients with disseminated malignancy and the potential of PET- CT to evaluate the whole body in a single study and to identify metastases even in rare sites.
Positron Emission Tomography Computed Tomography
Small Cell Lung Carcinoma/diagnostic imaging
One Bronchus too Many: A Rare Bronchoscopy Finding
Benign yet Suspicious: Sclerosing Pneumocytoma Uncovered in Cancer Staging
Pulmonary Sclerosing Hemangioma/diagnostic imaging
ESMO 2025 and the Future of EGFRm NSCLC Sequencing: First-line Choices that Preserve Subsequent Therapy Eligibility
The therapeutic landscape for EGFR-mutated non-small-cell lung cancer (NSCLC) has rapidly evolved with the advent of thirdgeneration tyrosine kinase inhibitors (TKIs), bispecific antibodies, and antibody–drug conjugates (ADCs). Despite substantial improvements in first-line efficacy, a significant proportion of patients fail to reach targeted second-line therapies because of rapid clinical decline at progression. This concise review synthesizes evidence from phase II-III clinical trials and recent real-world data to evaluate how current first-line strategies influence the feasibility of subsequent therapies, with particular attention to central nervous system (CNS) risk, co-mutational biology, and treatment tolerability. Osimertinib monotherapy remains the global standard owing to its robust systemic and intracranial efficacy. The addition of chemotherapy, as shown in FLAURA2, further enhances firstline tumor control but may compromise salvage opportunities by reducing the likelihood of preserving actionable resistance. The amivantamab-lazertinib combination provides clear benefit in biomarker-defined high-risk disease but often limits the potential to reuse TKI-based approaches later in the course of treatment. Across studies, approximately 35%-40% of patients are unable to receive a targeted second-line regimen, and real-world survival after osimertinib failure is frequently restricted to 8-12 months. These data collectively suggest that the optimal first-line approach in EGFR-mutated NSCLC is not simply the regimen with the longest progression-free survival but rather the one that preserves access to subsequent effective therapies. Clinical decisions at diagnosis must therefore be made with downstream eligibility in mind, ensuring that patients remain candidates for HER3- and TROP2-directed ADCs and other emerging agents that are likely to shape survival beyond the first-line setting.
Will Spatial Transcriptomics Transform Pathology?
Spatial transcriptomics (ST) is an emerging technology that maps gene expression directly onto tissue architecture. As it moves toward clinical adoption, ST is poised to become an integral tool in precision diagnostics. Here, we discuss its potential to complement and enhance traditional morphological assessment, reinforcing the pathologist’s central role in the molecular era.
Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
Revisiting the Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer
Challenges of Staging Lung Cancer with the New TNM Classification (9th edition)
Triple-Dose Furmonertinib for Leptomeningeal Metastases in Advanced EGFR L858R-Mutated Lung Adenocarcinoma: A Case Report
Leptomeningeal metastases (LM) are a devastating complication of non-small cell lung cancer (NSCLC), particularly in patients with epidermal growth factor receptor (EGFR) mutations. Despite the success of EGFR tyrosine kinase inhibitors (TKIs), central nervous system (CNS) progression remains common and associated with poor outcomes due to limited drug penetration. We report a 73-year-old woman with EGFR L858R-mutated NSCLC who developed LM after multiple lines of therapy, including gefitinib, osimertinib, chemotherapy, anti-angiogenic therapy, and radiotherapy. Treatment with high-dose furmonertinib (240 mg daily) combined with bevacizumab resulted in symptom relief and additional survival. Remarkably, her overall survival exceeded six years from initial diagnosis. This case highlights the potential role of dose-escalated furmonertinib as salvage therapy in LM after osimertinib resistance and underscores the importance of sequential and multimodal management in advanced EGFR-mutant NSCLC.
Clinical Outcomes of Thoracic Cancer Patients Requiring ICU Admission: A 10-Year Retrospective Study
Introduction Lung cancer is the most common solid malignancy requiring intensive care unit (ICU) admission, but ICU admission for cancer patients is often denied, being the second most common reason for refusal. This study aimed to evaluate the outcomes of thoracic cancer patients admitted to the ICU and understand the characteristics that may affect these outcomes. Methods This retrospective cohort study analyzed 25 patients with lung cancer admitted to the ICU between 2014 and 2023 at the Multidisciplinary Thoracic Tumors Unit of a tertiary hospital in Portugal. Clinical characteristics and survival outcomes were assessed. Results Patients had a median age of 68 years, were predominantly male (72%), and mostly had stage IV disease (76%). Over 10 years, ICU admissions for thoracic cancer patients increased, with septic shock being the primary reason for admission. Respiratory and cardiovascular dysfunctions were prevalent, requiring frequent respiratory support. Mortality rates were 60% at 28 days, 72% at 6 months, and 76% at 12 months. Higher SOFA and SAPS II scores, hematological dysfunction, and invasive mechanical ventilation were associated with higher 28-day mortality. Conclusion ICU mortality was linked to severity at admission, not oncological disease burden. Survivors maintained functional status and continued treatment. Advancements in lung cancer therapies and rising survival rates emphasize the need to update ICU admission criteria and mortality predictor scores.
Immune Checkpoint Inhibitors/therapeutic use
Sequential T790M mutation testing and changes in the therapeutic approach after 2 lines of chemotherapy – clinical case
The EGFR mutation is identified in 10-50% of patients with non-small cell lung cancer (NSCLC). After first-line therapy, with 1st or 2nd line tyrosinacinase (TKI) inhibitors, in patients with NSCLC and a sensitizing EGFR mutation the most frequent mechanism of resistance is the acquisition of a T790M mutation, in 50-70%. We present the clinical case of a woman with NSCLC, cT2bN1M1b, stage IV with cerebral and adrenal metastasis at diagnosis and EGFR mutation. She underwent holocranial radiotherapy and treatment with erlotinib. Detection of T790M mutation after 2 chemotherapy regimens, with previous negative result on both liquid and histological biopsy for the detection ofT790M mutation. Eight years after diagnosis, she is functionally autonomous, asymptomatic, under therapy with osimertinib. This case illustrates the importance of knowledge of the resistance mechanism in patients with NSCLC and EGFR mutations, and the role of sequential rebiopsies.
Carcinoma, non-small-cell lung/drug therapy
carcinoma, non-small-cell lung/pathology
Descriptive analysis of PD-L1 expression in non-small cell lung carcinoma biopsies: two -year experience in a tertiary Hospital
Introduction: The expression of PD-L1 as a predictive marker of response to treatment of non-small cell lung cancer (NSCLC) allows the identification of patients most likely to benefit from treatment with inhibitors of immune checkpoints. The main objective of this study was to determine the PD-L1 positivity/negativity rates of biopsies diagnosed with NSCLC during the year 2017 and 2018 at CHUPorto and compare with the predicted rates. Materials and methods: All biopsies of lung, bronchus or pleura diagnosed with primary epithelial neoplasia were surveyed and categorized according to the age and sex of patients, the reported diagnosis, the level of expression of PD-L1 and the mutational study. Results: Of the 262 cases identified, 57% were diagnosed with adenocarcinoma, 26% with squamous cell carcinoma, 11% with neuroendocrine neoplasia and 6% with others. PD-L1 expression was evaluated in 215 biopsies out of 229 recorded with the diagnosis of NSCLC. Of these 215 cases, 54% were negative, 26% showed mild to intermediate positivity and 20% high positivity for PD-L1. Discussion and conclusion: The evaluation of PD-L1 expression in lung cancer biopsies is an essential tool for defining the treatment of these patients. The values of PD-L1 expression described here in the clinical practice of CHUPorto tend to be more negative than those described in the original clinical trial, but similar to those described by real-life studies. Given the impact that the expression of PD-L1 has on the management of patients with NSCLC in daily clinical practice, it is important to know our reality. As future perspectives, we consider important the correlation analysis of PD-L1 expression with the results of treatment with inhibitors of immune checkpoints.
LENT score in prognostic assessment of malignant pleural effusion – the impact of target therapy
Introduction: Malignant pleural effusion (MPE) is a common manifestation in patients with advanced lung cancer. The LENT score was developed as a risk stratification system to predict the survival of these patients. However, following the discovery of molecular markers and a new era of personalized therapy, prognostic estimation became a challenging exercise. The aim of this study was to evaluate the performance of LENT score in predicting MPE survival in EGFR and ALK mutated lung adenocarcinoma. Methods: A retrospective single-center study of patients with MPE from lung adenocarcinoma followed between January 2008 to December 2018. Results: Forty-two patients were included in the study (mean age 76.4 ± 12.6 years, 52% female). Of these patients, 29% exhibited EGFR gene mutation or ALK gene translocation and received tyrosine kinase inhibitor therapy (TKI), in contrast to 71% of patients without identification of mutational factors and receiving conventional chemotherapy. Based on LENT score, in the sub-group treated with conventional chemotherapy, 67% had a moderate-risk category and 33% a high-risk category, with a median overall survival (OS) of 109 (31-406) and 36 (11-77) days, respectively. In the sub-group treated with targeted therapy, 75% were in a moderate-risk category and 25% in a high-risk category with a median OS of 1033 (245-1710) and 238 (27-not available) days, respectively. Patients receiving targeted therapy had a longer survival than patients receiving conventional chemotherapy in all LENT score risk categories (p<0.05). Conclusions: OS in patients with MPE due to lung adenocarcinoma was similar to that predicted by the LENT score, except for patients with EGFR mutation or ALK translocation. In this subgroup, the LENT score seems to underestimate the prognosis. Although this study has limitations regarding sample size, it does reveal, in the present time, some inaccuracy of the LENT score, demonstrating that it needs to be reviewed and revalidated in view of recent therapeutic advances.
Stereotactic body radiotherapy in primary lung disease: Experience of a portuguese center
Background: Stereotactic body radiation therapy (SBRT) is the primary alternative to surgery for patients with clinical stage I or II non -small cell lung cancer (NSCLC) who have significant comorbidity that precludes safe resection and for those who refuse surgery. Methods: Patients with clinical stage I or II NSCLC treated with SBRT in our institution between January 2015 and December 2019 were retrospectively analyzed. Patient characteristics, treatment -related outcomes and toxicities were analyzed. Control and survival rates were calculated using the Kaplan -Meier method. Acute and late toxicities were graded according to the CTCAE v4.0. Results: 110 patients were identified, 78 men and 32 women, with a median age of 75,5 years (50 -90 years), and a ECOG performance status of 0 or 1 in 73% of these patients. Of the biopsy proven cases (65%), 36% were adenocarcinomas and 21% were squamous cell carcinomas. 65% patients were staged as IA (T1N0), 33% as IB (T2aN0) and 2% as IIB (T3N0), all of which were clinically staged with PET -CT. The majority of the tumors (70%) were peripherally located, with a median size of 24.3mm. 48Gy in 4 fractions was the most prescribed scheme (70%), followed by 50Gy in 5 fractions (17.3%). 110 patients were eligible for assessment of recurrence. With a median follow -up of 53 months (IC95% 42 to 57 months), 32 patients (29.1%) had disease recurrence, of which 10% failed locally, 7.3% had regional failure and 22.7% distant failure. The 2 - and 5 -year local control was 91% and 85%, respectively. The 2 - and 5 -year regional control were both 92%, and the distant metastasis free survival and overall survival (OS) were 80% and 67%; 75% and 45%, respectively. Median OS was 51,3 months. No grade 3 toxicity was reported. Late grade 2 toxicity occurred in 26% of patients (11% pneumonitis, 7% fatigue, 2% rib fracture, 4% chest wall pain, and 2% esophagitis). Prognostic factors correlated with better OS were: age <70 years (p = 0.03), female gender (p = 0.005), absence of cardiac and/or pulmonary comorbidities (p = 0.03) and good performance status 0 -1 (p = 0.001). Conclusion: High rates of local control were achieved in our population of early stage NSCLC patients treated with SBRT, with good survival outcomes and toxicity profile, comparable to other published data. SBRT is safe and efficacious in the definitive treatment of patients with early stage NSCLC (I/II).
Comprehensive Evaluation of Peripheral Immunodynamics in Advanced Non-Small Cell Lung Cancer Associated to Chemotherapy and Immunotherapy
Introduction: Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has transformed the treatment landscape for advanced non-small cell lung cancer (NSCLC). Despite significant benefits for some patients, durable responses are limited to 20%–30% of cases, necessitating predictive biomarkers for better therapeutic guidance. While tumor-based markers such as PD-L1 expression and tumor mutational burden offer partial insights, peripheral blood biomarkers have emerged as promising minimally invasive tools for monitoring immune dynamics and predicting outcomes. Methods: This prospective pilot study analyzed the immune profiles of 51 NSCLC patients across three therapy groups—diagnostic (DX), chemotherapy (CT), and ICI-treated (ICB)—using high-dimensional flow cytometry and advanced computational algorithms. Results: Compared to healthy controls, NSCLC patients exhibited significant alterations in immune subsets, including elevated regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs). Therapy-specific changes included increased effector and activated T cells (e.g., HLA-DR+CD38+ Th1 cells) and dendritic cell subtypes, particularly cDC2, in the ICB group. In contrast, chemotherapy was associated with heightened Tc2 and activated CD8 T cells. Importantly, distinct immune signatures correlated with therapeutic outcomes. Non-progressors (stable disease or partial response) under ICB displayed higher levels of switch-memory B cells and cDC1, while progressors showed increased naïve B cells and cDC2. These findings highlight the immunomodulatory effects of different therapies and the potential of peripheral biomarkers for treatment stratification. Results: This study underscores the need for further validation of peripheral blood biomarkers and their integration into clinical decision-making to optimize NSCLC immunotherapy outcomes.
Carcinoma, Non-Small-Cell Lung/immunology
Immune Checkpoint Inhibitors/pharmacology
Therapeutic Targets in Non-Small Cell Lung Cancer: Current Progress and Future Directions
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases, representing the majority of cancer-related deaths worldwide. Recent advances have shifted treatment paradigms from conventional chemotherapy to precision oncology approaches, particularly molecularly targeted therapies. This review focuses on pivotal molecular drivers such as EGFR, ALK, KRAS, MET, HER2, and RET, synthesizing content from recent studies and editorial perspectives. Targeted therapies, particularly tyrosine kinase inhibitors (TKIs), have redefined patient care by improving progression-free and overall survival. However, resistance mechanisms remain a challenge, necessitating innovative strategies and combination approaches. This article integrates perspectives to provide a comprehensive overview of NSCLC target therapeutic progress and future directions.
Protein Kinase Inhibitors/therapeutic use
Digital Image Analysis and Artificial Intelligence in Lung Cancer Pathology
Operability versus Resectability in Non-Small Cell Lung Cancer: A Multidisciplinary Perspective
Carcinoma, Non-Small-Cell Lung/pathology
Investigator-Led Clinical Research in Thoracic Oncology: Are We Able to Do It?
9.º CONGRESSO PORTUGUÊS DO CANCRO DO PULMÃO Grande Hotel Sta. Eulália – Albufeira 21 a 23 de Outubro de 2021
Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
Two-year treatment with Pembrolizumab monotherapy in advanced non-small cell lung cancer: a reflection based on real-world data
Introduction and objectives: Immunotherapy has introduced advances in the treatment of non -small cell lung cancer. However, data from current clinical practice on potential responder groups, optimal duration of treatment and safety issues remain unclear. It is intended to produce a reflection on the population of patients with a favourable response to Pembrolizumab and how they have evolved clinically over time. Materials and methods: Retrospective study of patients who completed at least 2 years/35 cycles of Pembrolizumab was conducted, with descriptive analysis of clinicopathological characteristics and medical results obtained during the follow -up period. Results: Twenty -three patients were identified, mostly men (95.7%), diagnosed with adenocarcinoma (78.3%) at an average age of 62.0 -year -old, with good functional status. During treatment, 69.6% of cases achieved an objective response. At the time of the study, with a median follow -up of 35.2 months, 17 patients were alive and in remission (73.9%), 7 of which (41.1%) with disease controlled for more than 32.6months (maximum observed of 48.7) months; among those who progressed (13.0%), only 1 achieved a partial response again within 5.1 months of reintroduction of immunotherapy. Grade >2 adverse events occurred in 9 patients (39%), leading to different clinical outcomes; of these, 44% showed recurrence even after suspension of immunotherapy. Discussion and conclusions: The data seem to support the potential lasting benefit of Pembrolizumab described in recent studies, with a manageable, although not negligible, safety profile. In the absence of relevant toxicity and in the face of disease progression, a second course may be considered. However, more prospective, and multicenter studies, with a larger sample and a longer follow -up period, are needed to support these data.
A multicentric analysis of prognostic factors in malignant pleural mesothelioma
Background: Malignant pleural mesothelioma is a rare entity with poor prognosis, linked to previous asbestos exposure. The main goal of this study was to analyse the impact of clinical factors on mesothelioma prognosis. Methods: Retrospective cohort study of patients with malignant pleural mesothelioma in three Portuguese institutions, from 1999 to 2020. Statistical analysis was performed with Kaplan–Meier method and Cox regression using IBM SPSS® v25. Results: 60 patients were included, with male predominance (70%) and a median age of 69 years old. At diagnosis, 61% had advanced TNM stage (TNM III-IV) and 18% had an ECOG-PS ≥ 2. Asbestos exposure was stated in 48%. Epithelioid mesothelioma was the most prevalent histological subtype (81%). The majority received first line chemotherapy, in 10% combined with surgery, and two patients received immunotherapy after progression. Median overall survival (OS) was 13 months and median progression free survival was 10 months. A lower OS was observed in patients with ECOG-PS ≥ 2, age ≥ 70 years, TNM stage III-IV, anaemia, and hypoalbuminemia. Applying the decision tree model proposed by Brims et al. in our population, a significant difference in median OS was observed between the risk groups. In a multivariate analysis using Cox regression, Brims risk group 4, older age and advanced TNM stage were identified as independent negative prognostic factors. Conclusion: Recognition of these prognostic factors at diagnosis and use of specific prognostic models can help guide malignant pleural mesothelioma management.
20 years managing malignant pleural mesothelioma: a review of our experience and the quest for the optimal prognostic marker
Introduction: Malignant pleural mesothelioma (MPM) is a rare, but aggressive incurable cancer. A variety of prognostic tools have been developed to guide clinicians and patients in the management of MPM regarding the most appropriate therapy and survival time. Objectives: To evaluate the usefulness of the Brims’ decision tree analysis, the EORTC prognostic score, the CALGB prognostic groups, the modified Glasgow Prognostic Score (mGPS), and the LENT prognostic score in our MPM patients. Methods: Local retrospective database analysis of patients with MPM diagnosed between 2000 and 2020. The different prognostic scores were applied and MPM group risks’ evolution was analyzed. Statistical analysis was performed with IBM® SPSS® Statistics 25. Results: A total of 67 patients were evaluated (55 males, 82.1%). Epithelioid MPM was the commonest histological type (51 patients, 76.1%). Median overall survival (OS) was 11 months (IQR 23) and median progression free-survival (PFS) was 7 months (IQR 12.5). Survival distributions were statistically significantly different for the Brims’ and the mGPS’ groups (respectively, χ2 = 7.188, p = .027, and χ2 = 6.46, p = .04). For EORTC, CALGB and LENT score, there were not statistically significant differences in survival distributions (respectively, χ2 =.57, p = .811; χ2 = 7.978, p = .157; and χ2 = 1.23, p = .267). Brims’ model and mGPS statistically significantly predicted OS (respectively, F(1,57) = 11.1, p < 0.01, and F(1,32) = 6.846, p = .01). EORTC, CALGB and LENT failed to statistically significantly predict OS (respectively, F(1,44) = .003, p = .955; F(1.43) = .722, p = 0.4; and F(1,14) = 1.193, p = .293). Conclusion: The small number of patients included and missing data for some parameters are limitations of our analysis. However, to our knowledge, this was the first study and the largest cohort to address MPM prognostic scores in our country. In our cohort, the Brims’ model and mGPS were useful in predicting survival. Both are simple tools with easily accessible parameters and should be considered for clinical practice.