Clinical and biologic prognostic factors in malignant pleural mesothelioma

Our plain-English summary of Clinical and biologic prognostic factors in malignant pleural mesothelioma, by V. Ambrogi, T.C. Mineo, Multidisciplinary Tor Vergata University Study Group for Malignant Pleural Mesothelioma (Thoracic Cancer, 2012).

The study

• Authors: V. Ambrogi, T.C. Mineo, Multidisciplinary Tor Vergata University Study Group for Malignant Pleural Mesothelioma
• Journal: Thoracic Cancer
• Published: 2012;3(4):289-302
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an extremely aggressive neoplasm of the pleura mainly attributable to asbestos exposure. Conventional medical, physical, and surgical treatments and their combinations are basically ineffective and just a few subjects experience some benefit. No definite guidelines can be provided in patient selection and therapeutic strategies. Currently, malignant pleural mesothelioma therapy is guided by clinical stage and patient characteristics, which are quite unreliable, rather than by the histological or molecular features of the tumor. In the present review the impact on prognosis of classic (i.e. etiology, age, gender, histology, staging), as well as relatively new clinical factors such as quality of life, positron emission tomography assessment, and occult residual disease, are firstly evaluated. In the second section of the review several biological variables and genetic markers, which have been recently recognized as the bases of the disease onset and development, are listed and discussed. There are serum and tissue markers. The latter are mainly related to cell cycle regulation, apoptosis, and growth factor pathways. These novel factors may play an important role in defining the prognosis of the disease and, subsequently, may have a place in addressing therapy.

© 2012 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty. Ltd.

In plain English

This was an invited review of published research on factors that may predict survival in malignant pleural mesothelioma. It did not report new patient data. The first part covered clinical factors: prognostic scoring systems, asbestos exposure, age, sex, performance status, quality of life, symptoms, blood tests, histology, staging, CT and PET scans, and microscopic disease left after surgery. The second part covered blood and tissue biomarkers and genetic changes. In the studies it described, an EORTC scoring system gave one-year survival of 40% in patients predicted to have a good prognosis against 12% in those predicted to have a poor prognosis. One study of 70 patients who had extrapleural pneumonectomy reported prior asbestos exposure as by far the most significant predictor of poor prognosis. A proposed staging revision restricted to epithelial mesothelioma, and not yet universally accepted, gave median survival of 51 months at stage I and eight at stage IV. The authors concluded that histology and performance status were the only prognostic factors of clinical importance for routine use. They said many biological factors were not yet sufficiently validated.

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: Invited narrative review of published studies (no new patient data; no search method described)
• Who was studied: Published studies of patients with malignant pleural mesothelioma; the review does not state how many studies were included or how they were selected
• Exposure: Not an exposure study. The review examined clinical, biological and genetic prognostic factors. It discussed asbestos exposure mainly as a risk factor rather than a prognostic factor; no fiber types were specified.
• Main results:
  • In the EORTC prognostic scoring system (Curran et al.) as described by the review, one-year survival was 40% in patients with a good prognosis against 12% in patients predicted to have a poor prognosis
  • Yan et al. reported that among 70 patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma, prior asbestos exposure was by far the most significant predictor of poor prognosis
  • A proposed revision of staging restricted to mesotheliomas with epithelial histology (Richards et al.), not yet universally accepted, gave median survival of 51 months at stage I, 26 at stage II, 15 at stage III and eight at stage IV
  • Lopez Rios et al. found median survival of 10 months in cases with homozygous deletion (of p16) versus 34 months in non-deleted cases
  • Gill et al. found that a CT-derived tumor volume greater than 319 cm3 was an independent predictor of survival in 338 patients with epithelial mesothelioma after extrapleural pneumonectomy
  • In a review by Hillerdal et al., 50% of mesotheliomas were epithelial, 34% mixed and 16% sarcomatoid types
• The authors' conclusion: The authors concluded that histology and performance status are the only prognostic factors of clinical importance that may routinely be used in managing patients with malignant pleural mesothelioma. In their view, the practical use of many biological factors is limited because they are not yet sufficiently validated.
• Limitations the authors state:
  • The authors stated that the role of biological and genetic markers as prognostic predictors is still under investigation and should be validated in larger, controlled studies
  • The authors stated that the relatively low number of patients per year hinders prospective analysis needed to validate staging systems

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleura, Asbestos Exposure, Prognosis, Etiology, Histology, Staging.

Related studies

• A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2010)
• The effect of clinical covariates on the diagnostic and prognostic value of soluble mesothelin and megakaryocyte potentiating factor — K. Hollevoet, K. Nackaerts, et al. (2012)
• Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting — T. Ringgaard Petersen, V. Panou, et al. (2021)
• Clinical outcomes and prognostic factors of patients with advanced mesothelioma treated in a phase I clinical trials unit — D. Papadatos-Pastos, D. Roda, et al. (2017)
• Biologic, cytogenetic, and molecular factors in mesothelial proliferations — J. Hicks (2006)
• Malignant peritoneal mesothelioma: prognostic significance of clinical and pathologic parameters and validation of a nuclear-grading system in a multi-institutional series of 225 cases — D.B. Chapel, J.J. Schulte, et al. (2021)

Browse more research in Thoracic Cancer, or return to medical research.