Ki67 index is an independent prognostic factor in epithelioid but not in non-epithelioid malignant pleural mesothelioma: a multicenter study

BACKGROUND: Estimating the prognosis in malignant pleural mesothelioma (MPM) remains challenging. Thus, the prognostic relevance of Ki67 was studied in MPM. METHODS: Ki67 index was determined in a test cohort of 187 cases from three centres. The percentage of Ki67-positive tumour cells was correlated with clinical variables and overall survival (OS). The prognostic power of Ki67 index was compared with other prognostic factors and re-evaluated in an independent cohort (n=98). RESULTS: Patients with Ki67 higher than median (>15%) had significantly (P<0.001) shorter median OS (7.5 months) than those with low Ki67 (19.1 months). After multivariate survival analyses, Ki67 proved to be-beside histology and treatment-an independent prognostic marker in MPM (hazard ratio (HR): 2.1, P<0.001). Interestingly, Ki67 was prognostic exclusively in epithelioid (P<0.001) but not in non-epithelioid subtype. Furthermore, Ki67 index was significantly lower in post-chemotherapy samples when compared with chemo-naive cases. The prognostic power was comparable to other recently published prognostic factors (CRP, fibrinogen, neutrophil-to-leukocyte ratio (NLR) and nuclear grading score) and was recapitulated in the validation cohort (P=0.048). CONCLUSION: This multicentre study demonstrates that Ki67 is an independent and reproducible prognostic factor in epithelioid but not in non-epithelioid MPM and suggests that induction chemotherapy decreases the proliferative capacity of MPM

A scale for decision making between whole lung transplantation or lobar transplantation

In lung transplantation, appropriate size matching is of crucial importance to achieve satisfactory outcomes. Tailoring of the lung has been repeatedly described as successful means of overcoming size disparities. The goal of this study was to define a parameter helping the surgeon in the decision whether a standard lung transplantation or a lobar transplantation should be anticipated. Methods: We retrospectively analysed the ratio between donor total lung capacity (TLC) and recipient TLC in all lung-transplant procedures performed in our institution from 1 January 2008 to 30 November 2008. The utility of this ratio using predicted recipient TLC (D/pR index) and real recipient TLC (D/rR index) in discriminating between whole lung transplantation and lobar transplantation was studied with the receiver operating characteristic (ROC) analysis. Results: The median D/pR index in whole lung transplantations was 1.01 (range: 0.69—1.26) and 1.19 in lobar transplantation (range: 1.09—1.54). In the range between 1.12 and 1.14, sensitivity and specificity are both above 90%. The area under the ROC curve for D/pR index was 0.96. The median D/rR index in whole lung transplantations was 0.95 (range: 0.56—2.74) and 1.58 in lobar transplantation (range: 0.85—2.56). The area under the ROC curve was 0.73. Conclusions: We conclude that the D/pR index is more useful than D/rR index in discriminating between whole lung transplantation and lobar transplantation. With an area under the ROC curve of 0.96, this seems to be a suitable indicator in deciding between whole lung transplantation and lobar transplantation