A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma

Our plain-English summary of A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma, by A.C. Tanrikulu, A. Abakay, M.A. Kaplan, et al (Respiration; International Review of Thoracic Diseases, 2010).

The study

• Authors: A.C. Tanrikulu, A. Abakay, M.A. Kaplan, M. Küçüköner, Y. Palanci, O. Evliyaoglu, C. Sezgi, H. Sen, A.İ. Carkanat, G. Kirbas
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2010;80(6):480-7
• Cited by: 58 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) has a poor prognosis.

Objectives: Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM.

Methods: We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients' charts.

Results: The mean age of 363 patients (217 men, 146 women) was 50.6 ± 11.2 years (range 19-85) and the mean survival time was 11.7 ± 8.6 months (range 1-53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score ≤60, a pleural fluid glucose level ≤40 mg/dl, a C-reactive protein level >50 mg/l, a serum lactate dehydrogenase level >500 U/l, the presence of pleural fluid, pleural thickening >1 cm and a platelet count of >420 × 10(3)/μl were found to be associated with poor prognosis in MPM.

Conclusions: Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly.

Copyright © 2010 S. Karger AG, Basel.

In plain English

Researchers at Dicle University in Diyarbakir, Turkey, reviewed hospital records of 363 patients with malignant pleural mesothelioma registered from January 1989 to March 2010. The patients were 217 men and 146 women, mean age 50.6 years; the authors reported environmental asbestos exposure in 85.1%. The authors tested 22 features measured at diagnosis against survival. Mean survival was 11.7 months. Seven features were linked to poorer survival in the final model. Their hazard ratios (comparing death rates over time) and 95% confidence intervals were:

• Karnofsky performance score below 60: 2.25 (1.623 to 3.118)
• pleural fluid glucose of 40 mg/dl or less: 1.73 (1.222 to 2.451)
• C-reactive protein above 50 mg/l: 1.56 (1.139 to 2.105)
• serum lactate dehydrogenase above 500 U/l: 2.24 (1.585 to 3.168)
• pleural fluid present: 2.90 (1.869 to 4.527)
• pleural thickening over 1 cm on CT: 2.15 (1.520 to 3.025)
• platelet count above 420,000 per microliter: 1.33 (lower limit 1.009, upper limit misprinted)
  Asbestos exposure was not significantly associated with survival. The authors concluded these factors were associated with poor prognosis, and noted the study was retrospective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of hospital charts, with survival analysis (Kaplan-Meier method, Cox proportional hazards regression)
• Who was studied: 363 patients with histologically proven malignant pleural mesothelioma (217 men, 146 women; mean age 50.6 years, range 19 to 85), registered and followed up at Dicle University hospital in Diyarbakir, southeastern Turkey, from January 1989 to March 2010
• Exposure: Environmental asbestos exposure, recorded as yes or no. It was present in 309 of 363 patients (85.1%), with a mean exposure duration of 32.5 years. The article does not name fiber types. The study's main subject was prognostic factors measured at diagnosis, not exposure.
• Main results:
  • Mean survival time for all 363 patients was 11.7 months (range 1 to 53 months).
  • In the multivariate model, a Karnofsky performance score below 60 had a hazard ratio of 2.25 (95% CI 1.623 to 3.118, p 0.001), compared with 60 or above. The text gives the cut-off as 60 or below.
  • Pleural fluid glucose of 40 mg/dl or less had a hazard ratio of 1.73 (95% CI 1.222 to 2.451, p 0.002), compared with above 40 mg/dl.
  • C-reactive protein above 50 mg/l had a hazard ratio of 1.56 (95% CI 1.139 to 2.105, p 0.005), compared with 50 mg/l or less.
  • Serum lactate dehydrogenase above 500 U/l had a hazard ratio of 2.24 (95% CI 1.585 to 3.168, p 0.001), compared with 500 U/l or less.
  • Presence of pleural fluid had a hazard ratio of 2.90 (95% CI 1.869 to 4.527, p 0.001), compared with no pleural fluid. In the univariate analysis, median survival was 9.00 months for the 330 patients with pleural effusion and 20.00 months for the 33 without.
  • Pleural thickening over 1 cm on chest CT had a hazard ratio of 2.15 (95% CI 1.520 to 3.025, p 0.001), compared with 1 cm or less.
  • A platelet count above 420 thousand per microliter had a hazard ratio of 1.33 (lower confidence limit 1.009, p 0.043), compared with 420 thousand or less. The upper confidence limit is misprinted in the table.
  • In the univariate analysis, asbestos exposure was not significantly associated with survival. Median survival was 10.00 months both for the 309 patients with exposure (290 deaths) and for the 54 without (47 deaths), p 0.172.
• The authors' conclusion: The authors concluded that low pleural fluid glucose, high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor prognosis in malignant pleural mesothelioma. In the discussion they also listed performance score, platelet count and serum lactate dehydrogenase as significant predictors of survival.
• Limitations the authors state:
  • The study was retrospective.
  • Some markers were not studied (the authors name soluble mesothelin-related peptide, osteopontin and megakaryocyte potentiating factor).

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Dyspnea, Lactate Dehydrogenase (LDH), Pleural Thickening.

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