Peritoneal Malignant Mesotheliomia
Reviewer Comments
The Peritoneal Mesothelioma case series with the overall most remarkable
survival outcomes that we could find in the literature was reported
by Plauss (Peritoneal Mesothelioma. Arch Surg. 123;1988:763-66).
In that study, 2 of 12 patients remarkably survived 102 and 120
months, respectively. The mean survival for thepopulation is 2.24
years, with a median of 12 months. The standard deviation is 40.22
months.
We applied Dr. Jonas= endpoint of extended quality survival= mean
+ 2 standard devi-ations, but made it even more rigorous by employing
the 95% prediction interval accord-ing to Hahn and Meeker (in Motulsky,
Intuitive Biostatistics. 1995, Oxford University Press: 42) According
to this formula, which employs K + 2.29 standard deviations as the
95% prediction interval for a comparative sample of 12, only those
patients surviving beyond 119.12 months could be considered to have
had outcomes remarkable by comparison. (The 120=month survivor,
deceased at the time of the report by Plauss, is marginal, and therefore
representative of the prediction interval.
2 LAT periitoneal mesotheelioma patients included in this review
are alive and functional with disease well beyond that point. One
is alive at 180 months (3.6 times the standard deviation beyond
the mean), and the other is alive at 216 months (4.5 times the standard
deviation), or 15 and 18 years respectively. (Now 19 and 21 years
respectively).
Case #4 - Status alive at 3.6 times the standard deviation
from the mean (when compared with Plauss, see overview report).
Case #5 - Status alive at 4.5 times the standard deviation
from the mean (when compared with Plauss, see overview report).
*Lt. Col Wayne Jonas, M.D., past director of OAM suggested an alternative
endpoint for the best case series. As adopted by NCI, the best case
series, has a sole endpoint: tumor regression. Dr. Jonas suggests
that a survival endpoint (mean + 2 standard deviations) is also
of interest.
(from Gar & Christine Hildenbrand, Field Investigations
& Epidemiology, National Foundation for Alternative Medicine.)
