Analysis of survival of mesothelioma cases in the Italian register (ReNaM)

Our plain-English summary of Analysis of survival of mesothelioma cases in the Italian register (ReNaM), by A. Marinaccio, M. Nesti, Regional Operational Centers (European Journal of Cancer, 2003).

The study

• Authors: A. Marinaccio, M. Nesti, Regional Operational Centers
• Journal: European Journal of Cancer
• Published: 2003;39(9):1290-5
• Cited by: 40 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The Italian National Mesothelioma Register (ReNaM) was set up at ISPESL (the National Institute for Occupational Safety and Prevention) in 1993. Five Italian regions (Piedmont, Liguria, Emilia-Romagna, Tuscany and Puglia, with a total of approximately 17500000 inhabitants) agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data to ISPESL. We describe an analysis of survival of 429 mesothelioma cases-392 pleural, 34 peritoneal and 3 in the pericardium-diagnosed during 1997, with variable follow-up from June 1999 to December 2001. The Kaplan-Meier method was used to estimate survival rates, the log rank non-parametric test and Cox proportional hazard model to assess the role of prognostic factors such as age, gender, morphology, level of diagnostic certainty and modality of exposure. Median survival was 275 days (95% confidence interval (CI) 241-309) for pleural mesotheliomas and 157 days (95% CI: 118-196) for peritoneal mesotheliomas. Survival after diagnosis of malignant pleural mesothelioma showed a statistically significant linear trend for age group at diagnosis, for males and females (P=0.006 and 0.008, respectively). The Cox proportional hazard model gave an adjusted relative risk (RR(adj)), for the fibrous histotype, of 2.96 (95% CI: 1.28-6.81; P=0.012) compared with cases with unspecified morphology; for epithelioid and biphasic morphologies, the risk was lower than unity. There was no significant difference in survival for cases with confirmed exposure (occupational, household or environmental) or without.

In plain English

This study used the Italian National Mesothelioma Register (ReNaM) to follow 429 people diagnosed with malignant mesothelioma in 1997 in five Italian regions. Of these, 392 cases were pleural, 34 peritoneal and 3 pericardial. Follow-up ran from June 1999 to December 2001. Median survival was 275 days (95% CI 241 to 309) for pleural and 157 days (95% CI 118 to 196) for peritoneal mesothelioma. Differences between men and women were not statistically significant. For pleural mesothelioma, survival was shorter with older age at diagnosis in both sexes. In the authors' model for pleural mesothelioma, the fibrous type had an adjusted relative risk of 2.96 (95% CI 1.28 to 6.81) compared with unspecified type. Cases with only a suspected diagnosis had an adjusted relative risk of 1.85 (95% CI 1.16 to 2.94) compared with definite cases. Survival did not differ significantly between cases with and without confirmed occupational, household or environmental asbestos exposure (adjusted relative risk 1.11, 95% CI 0.76 to 1.60). The authors concluded that age, tissue type and diagnostic certainty appear to be significant prognostic factors. Disease stage and treatment were not known.

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: Survival analysis of incident cases from a population-based mesothelioma register (Kaplan–Meier and actuarial survival estimates, log rank tests, Cox proportional hazard model)
• Who was studied: 429 cases of malignant mesothelioma diagnosed in 1997 in five Italian regions: Piedmont (136), Liguria (135), Emilia-Romagna (72), Tuscany (45) and Puglia (41). There were 392 pleural, 34 peritoneal and 3 pericardial cases. Follow-up ran from June 1999 to December 2001.
• Exposure: Asbestos exposure was reconstructed by interview and classified by an industrial hygienist. Cases with definite, probable or possible occupational, household or environmental exposure were compared with cases with unknown or unlikely exposure. No fiber types or doses are given.
• Main results:
  • Pleural mesothelioma (n=392): median survival was 275 days (95% CI 241–309). For males it was 279 days (95% CI 245–313) and for females 263 days (95% CI 184–342).
  • Peritoneal mesothelioma (n=34): median survival was 157 days (95% CI 118–196). For males it was 148 days (95% CI 84–212) and for females 252 days (95% CI 0–551).
  • Differences in survival between males and females were not statistically significant.
  • Pleural mesothelioma showed a significant linear trend of shorter survival with older age at diagnosis, for males (P=0.006) and for females (P=0.008). The Cox model confirmed this trend.
  • Males with pleural mesothelioma had a median survival of 312 days (95% CI 245–379) at age 0–64, 286 days (95% CI 216–356) at age 65–74, and 151 days (95% CI 116–186) at age 75 and over.
  • Females with pleural mesothelioma had a median survival of 375 days (95% CI 136–615) at age 0–64, 225 days (95% CI 130–320) at age 65–74, and 89 days (95% CI 0–195) at age 75 and over.
  • Histological type was not specified in 46% (179/392) of pleural cases. Of those specified, 162 were epithelioid, 28 biphasic and 23 fibrous.
  • Pleural mesothelioma, Cox model: the fibrous type had an adjusted relative risk of 2.96 (95% CI 1.28–6.81, P=0.012) compared with unspecified morphology. For epithelioid (0.99, 95% CI 0.67–1.47) and biphasic (0.90, 95% CI 0.44–1.84) morphology, the risk was lower than unity.
  • Pleural cases with a suspected rather than definite diagnosis had a significantly higher adjusted relative risk: 1.85 (95% CI 1.16–2.94, P=0.01).
  • In the pleural mesothelioma model, survival of cases with confirmed asbestos exposure (occupational, household or environmental) did not differ significantly from survival of cases without confirmed exposure. The adjusted relative risk was 1.11 (95% CI 0.76–1.60, P=0.6). The authors described survival in the two groups as much the same.
  • Variation in median survival for pleural mesothelioma between the five regional registers did not reach statistical significance.
• The authors' conclusion: The authors concluded that age at diagnosis, histological type and level of diagnostic certainty (when the stage of disease is not known) appear to be significant prognostic factors for mesothelioma.
• Limitations the authors state:
  • No information was available on disease stage at diagnosis or on treatment.
  • The data give no information on patients' quality of life.
  • Occupational and residential history could be reconstructed for only 198 of the 429 cases (46%).
  • The exposure assessment refers only to the occupational sector in which a case was exposed. The authors state it would be more complete if the amount of fibres inhaled could be estimated.
  • The male–female differences were probably not significant because of limited numbers, especially for peritoneal cases.
  • The longer survival of women with peritoneal mesothelioma led the authors to consider possible misclassification of female genital cancers.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pericardium, Median Overall Survival, confidence interval, Pleural Mesothelioma, Peritoneal Mesothelioma, Relative Risk, Epithelioid.

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