89 Targeting nuclear factor-kappa B in malignant pleural mesothelioma

Introduction: Staging provides limited prognostic information in Malignant Pleural Mesothelioma (MPM) making it difficult to have informed discussions with patients regarding the value of systemic palliative therapies and clinical trial enrolment. The modified Glasgow Prognostic Score (mGPS, based on C-Reactive Protein level and serum albumin), serum neutrophil-to-lymphocyte ratio (NLR) and serum platelet-to-lymphocyte ratio (PLR) have recently been correlated with prognosis in MPM. We aimed to assess their impact in West of Scotland patients. We also recorded histological sub-type, PS and mode of presentation. Methods: We retrospectively studied MPM patients diagnosed between January 2009 and December 2011. Patients were identified through coding of in-patient discharges from South Glasgow hospitals and an MDT database covering North Glasgow hospitals. The relationship between mGPS, NLR, PLR, histological sub-type, mode of presentation and survival were examined using Kaplan Meier methodology. Results: 106 patients were identified. Median age was 74 years (IQR 67 82). 91 were male (86%). 88 (83%) had a histological diagnosis and 85 (96.5%) of these patients had a calculable mGPS. PS was poorly recorded and not analysed. There was a trend towards poorer survival with increasing mGPS (log-rank for trend p = 0.048), but this did not reach overall significance (log-rank p = 0.11). NLR and PLR did not have any prognostic influence (p = 0.94, p = 0.19, respectively). Patients with epithelioid MPM had a better prognosis than those with sarcomatoid and biphasic histology (median survival 46, 21 and 7 weeks respectively, log rank p 0.0001). Those presenting as an emergency had a significantly poorer prognosis than those presenting to clinic (median survival 41 vs. 24 weeks, p = 0.01).