\[Clinical analysis of 45 patients with malignant pleural mesothelioma\]

Our plain-English summary of [Clinical analysis of 45 patients with malignant pleural mesothelioma], by J. Chen, W. Zhao, X. Liu, et al (Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 2012).

The study

• Authors: J. Chen, W. Zhao, X. Liu, Q. Tian, Z. Yang, L. Chen
• Journal: Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer
• Published: 2012;15(2):97-102
• Language: Chinese
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Objective: Malignant pleural mesothelioma (MPM) is a rare tumor with increasing incidence, and its early diagnoses and early treatments are difficult. The aim of the current study is to investigate the clinical features, diagnoses, and treatments of MPM, and provide reference for clinical use.

Methods: A total of 45 MPM patients admitted in the Chinese PLA General Hospital from January 1997 to December 2010 and their clinical records were analyzed retrospectively.

Results: The major clinical symptoms of the patients included: chest pain (53.33%), chest distress (48.89%) and cough (37.78%). The CT manifestations of MPM included: pleural thickening (71.11%), pleural effusion (60%) and lung shadow (40%). The pleural fluid was exudative. The number of nucleated cells in the fluid increased, most of which were mononuclear cells. Moreover, the lactic acid dehydrogenase (LDH) levels in the culture medium significantly increased. The most common clinical stage of MPM patients was either stage of III or IV. Thoracoscopy was one of the main diagnosis methods, and epithelium cell type was the main pathologic type. In addition, MPM was easily misdiagnosed as tuberculous pleurisy. Patients with an early stage of MPM were mainly cured through surgery, whereas chemotherapy was applied for the patients with advance stage. The disease control rate of the patients with epithelial type was higher than that of the patients with fibrosarcoma type.

Conclusions: The rate of MPM misdiagnosis is high because most of the patients have untypical clinical symptoms. However, CT scan can provide an important basis for the diagnosis of MPM. The accurate diagnoses were based on pathological examinations and immunohistochemistry. The methods of treatment include chemotherapy, surgical operation, radiotherapy and supportive treatment. However, these treatments are still insufficient and require further studies.

In plain English

This was a retrospective review of the records of 45 patients with malignant pleural mesothelioma confirmed by tissue examination at the Chinese PLA General Hospital between January 1997 and December 2010. Patients averaged 52 years old (range 13 to 82), and 30 were male. Only 1 of the 45 (2.22%) had a recorded history of asbestos exposure. The most common symptoms were chest pain (53.33%), chest tightness or shortness of breath (48.89%) and cough (37.78%). Of the 45 patients, 39 (86.67%) had been misdiagnosed, most often with tuberculous pleurisy. Most patients whose stage was known were stage III or IV. Among 16 patients treated with chemotherapy alone, 5 had disease control (tumor disappearance, shrinkage or stability), or 31.25%. Disease control was 55.56% in 9 stage I or II patients versus 14.29% in 14 stage IV patients. It was 37.5% in 16 epithelial-type versus 18.18% in 11 fibrosarcoma-type patients. No statistical tests were reported for these comparisons. The authors concluded that misdiagnosis was common because symptoms were non-specific, that confirmation required pathology with immunohistochemistry, and that treatment results were generally poor.

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 clinical records (case series)
• Who was studied: 45 patients with histopathologically confirmed malignant pleural mesothelioma at the Chinese PLA General Hospital, Beijing, January 1997 to December 2010; mean age 52 (range 13 to 82); 30 male (66.67%); occupations mainly administrative workers (cadres, 18) and retirees (8)
• Exposure: Asbestos exposure history was recorded, but only 1 of 45 patients (2.22%) had one. No fiber type is named. The authors suggested that other causes might be involved, such as SV40 virus infection, non-asbestos fibers, radiation, or genetic differences.
• Main results:
  • Main symptoms among the 45 patients: chest pain 24 (53.33%), chest tightness/shortness of breath 22 (48.89%), cough 17 (37.78%)
  • CT findings among the 45 patients: pleural thickening 32 (71.11%), pleural effusion 27 (60%), lung shadow 18 (40%)
  • In the 27 patients with pleural effusion, the fluid was always exudate. Malignant mesothelial cells were found on fluid cytology in only 2 of the 27 (7.41%).
  • Stage (UICC system): stage I 3, stage II 6, stage III 10, stage IV 14, unknown 12. Most patients were stage III or IV.
  • Diagnosis was made by thoracoscopy in 18 (40%), open surgical biopsy in 11 (24.4%), CT-guided needle biopsy in 9 (20%) and ultrasound-guided pleural biopsy in 7 (15.6%). Of 34 patients with immunohistochemistry, 16 were epithelial, 11 fibrosarcoma and 7 mixed cell type.
  • 39 of the 45 patients (86.67%) had been misdiagnosed. The most common misdiagnosis was tuberculous pleurisy (13 of 39, 33.33%), followed by lung cancer with pleural metastasis and pneumonia.
  • Advanced-stage (III, IV) patients were mostly treated with chemotherapy. Early-stage (I, II) patients were mostly treated with radical or palliative surgery.
  • Among 16 patients given chemotherapy alone (mostly cisplatin plus pemetrexed, 10 patients), 5 achieved disease control (DCR 31.25%).
  • Disease control rate: 5 of 9 stage I and II patients (55.56%) versus 2 of 14 stage IV patients (14.29%).
  • Disease control rate: 37.5% in 16 epithelial-type patients versus 18.18% in 11 fibrosarcoma (sarcoma) type patients. No statistical test is reported.
  • Disease control rate: 18.52% in 27 patients with pleural effusion versus 42.86% in 14 patients without effusion.
• The authors' conclusion: The authors concluded that misdiagnosis of malignant pleural mesothelioma was common because symptoms were non-specific. They said chest CT provided a basis for diagnosis, but confirmation required histopathology combined with immunohistochemistry. They added that treatments (chemotherapy, surgery, radiotherapy, supportive care) generally gave poor results and need further study.

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, Pleural Thickening, Pleural Effusion, Thoracoscopy, Epithelium, Tuberculous pleurisy, Chemotherapy, Misdiagnosis.

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