Abstract 1636P
Background
Malignant peritoneal mesothelioma (MPeM) is an aggressive cancer of the peritoneal lining of the abdominal cavity. Though early stage MPeM has better outcomes with multimodal treatment, advanced, non-resectable disease has a poor prognosis. No prognostic indicators are available to inform clinical decision-making. We hypothesize inflammatory biomarkers may provide a means of survival assessment.
Methods
448 patients were enrolled in Mesothelioma Natural History protocol NCT 01950572 at the NCI from 2013 to 2021. 159 were selected for MPeM and assessed within 7 days of enrollment for levels of soluble mesothelin-related peptide (SMRP), CA125, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), fibrinogen, and platelet count using the Biomedical Translational Information System (BTRIS) and Labmatrix applications. For each biomarker, patients were separated into quartiles per levels. Quartiles were compared for overall survival (OS) with Kaplan-Meier curves, and p-values were calculated with log rank tests. A COX regression model was applied to adjust for other explanatory variables.
Results
Median age of diagnosis, median age at enrollment and median OS from enrollment were 52, 57, and 3.2 years, respectively. OS decreased significantly from the lower 2 to the higher 2 quartiles for every biomarker (p-values < 0.0001). For CRP and fibrinogen, the difference in survival was significant between each quartile. Per the COX regression model, CRP was the best independent predictor of OS (p < 0.05). The table depicts survival percentage of patients at 24 months from enrollment: Table: 1636P
| 24-month survival (%) | |||
| Highest quartile | Middle 2 quartiles | Lowest quartile | |
| SMRP | 11.1% | 47.8% | 56.4% |
| CRP | 18.8% | 46.1% | 61.4% |
| Fibrinogen | 17.1% | 47.5% | 66.7% |
Conclusions
Tumor-specific and inflammatory biomarkers are accessible labs capable of prognostic assessment in MPeM patients. CRP shows the greatest predictive value and may serve as the foundation for a prognostic scoring model. Patients with lower biomarker levels tend to survive longer and are better targets for aggressive treatment over palliative care.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Raffit Hassan, M.D., Center for Cancer Research, National Cancer Institute, NIH.
Funding
Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research (Z01-BC-006150) given to RH.
Disclosure
All authors have declared no conflicts of interest.