Clinical and pathologic predictors of clinical outcome of malignant pleural mesothelioma

Our plain-English summary of Clinical and pathologic predictors of clinical outcome of malignant pleural mesothelioma, by R. Berardi, I. Fiordoliva, M. De Lisa, et al (Tumori, 2016).

The study

• Authors: R. Berardi, I. Fiordoliva, M. De Lisa, Z. Ballatore, M. Caramanti, F. Morgese, A. Savini, S. Rinaldi, M. Torniai, M. Tiberi, C. Ferrini, A. Onofri, S. Cascinu
• Journal: Tumori
• Published: 2016;102(2):190-5
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: Although worldwide use of asbestos has decreased, the incidence of malignant pleural mesothelioma (MPM) is expected to increase over the next few decades. A number of scoring systems has been proposed to assess clinicopathologic features and to predict the prognosis. We assessed the relationship between patients' features and disease evolution in order to choose the best treatment able to prolong overall survival (OS) and progression-free survival (PFS).

Methods: We retrospectively analyzed patients with locally advanced or metastatic MPM, treated at the Department of Medical Oncology, Università Politecnica Marche, Italy, from January 2003 to September 2013. Data on age, sex, smoking history, asbestos exposure, performance status, tumor stage, histology, type of treatment, and routine laboratory tests including complete blood count panel, date of death, or censored status were collected. The OS and PFS were estimated using Kaplan-Meier method and Cox analysis was performed to analyze the prognostic relevance of clinical parameters.

Results: We enrolled a total of 62 patients. Univariate analysis showed that histologic type, performance status, response to first-line therapy, pretreatment hemoglobin levels, and plasmatic Ca125 were significant prognostic factors. Conversely, no significant correlation was found between age, sex, smoking history, reported exposure to asbestos, stages at diagnosis, treatments, and OS and PFS.

Conclusions: Our results showed that anemia and increased Ca125 might be considered negative prognostic parameters in MPM patients and confirmed the prognostic role of histotype, performance status, and response to first-line chemotherapy.

In plain English

This was a retrospective study of 62 consecutive patients with locally advanced or metastatic malignant pleural mesothelioma treated at one medical oncology department in Ancona, Italy, between January 2003 and September 2013. The authors examined which patient, tumor and laboratory features were linked to overall survival and progression-free survival. Median overall survival was 12.5 months. In analyses of one factor at a time, survival was longer in patients with better performance status, with epithelioid histology (median 16.8 months, compared with 4.2 months for sarcomatoid and biphasic types), with a complete or partial response to first-line chemotherapy, and with pretreatment hemoglobin of 13 g/dL or more (median 16.8 versus 11 months). Pretreatment Ca125 was associated with overall survival but not with progression-free survival. Survival showed no significant link with age, sex, smoking, stage, or reported asbestos exposure, which 41 of the 62 patients had. Differences by surgery or chemotherapy regimen were not statistically significant. The authors concluded that anemia and raised Ca125 might be negative prognostic factors. They noted that the study was retrospective and small and that treatments varied.

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 study of consecutive patients from a single institution, examining prognostic factors for survival
• Who was studied: 62 consecutive patients with locally advanced or metastatic malignant pleural mesothelioma, treated at the Department of Medical Oncology, Università Politecnica Marche, Ancona, Italy, January 2003 to September 2013. Median age 68.5 years (range 48-81); 49 men and 13 women.
• Exposure: Asbestos exposure was recorded only as yes or no (yes for 41 patients, 66%; no for 21, 34%). It was one of several factors examined, alongside age, sex, smoking, performance status, stage, histology, treatments and blood tests. No fiber types, jobs or doses are given.
• Main results:
  • Median overall survival for all 62 patients was 12.5 months (range 0.7-48.6 months). Median progression-free survival after first-line therapy was 5.0 months.
  • Performance status (ECOG) at diagnosis was a significant prognostic factor (p = 0.002). Median survival was 16.8 months for ECOG 0, 13.5 months for ECOG 1, 1.8 months for ECOG 2 and 7 months for ECOG 3.
  • No significant correlation was found between overall or progression-free survival and age, sex, smoking history, or reported exposure to asbestos.
  • Median overall survival was 16.8 months for patients with pretreatment hemoglobin of 13 g/dL or more and 11 months for those with lower levels. The tables give p = 0.04 for overall survival and p = 0.01 for progression-free survival.
  • Patients who developed anemia at the end of first-line chemotherapy showed a trend toward poorer overall survival (median 12.6 vs 20.8 months), but this did not reach statistical significance.
  • Epithelial (epithelioid) histology was a favorable significant prognostic factor (median survival 16.8 months, p<0.0001; median progression-free survival 6.2 months).
  • Sarcomatoid and biphasic subtypes had a worse prognosis (median overall survival 4.2 months, median progression-free survival 1.8 months).
  • Plasma Ca125 measured before first-line chemotherapy was significantly associated with overall survival (p = 0.03) but not with progression-free survival. No Ca125 values or cutoff are given.
  • Survival did not differ by stage of disease (locally advanced vs metastatic).
  • Response to first-line chemotherapy was correlated with overall survival (p = 0.0003). Median survival was 29.2 months for complete response and 28.6 months for partial response, compared with 18 months for stable disease and 8.5 months for progressive disease.
  • Platinum plus pemetrexed was linked to longer median survival (14 months overall, 6.2 months progression-free) than other regimens. The differences were not statistically significant for overall survival (p = 0.60) or progression-free survival (p = 0.07).
  • Patients who had surgery showed a trend toward better overall survival (median 16.8 vs 12.3 months), which was not statistically significant (p = 0.89).
• The authors' conclusion: The authors concluded that anemia and increased Ca125 might be considered negative prognostic parameters in patients with malignant pleural mesothelioma. They also stated that the results confirmed the prognostic role of histotype, performance status and response to first-line chemotherapy.
• Limitations the authors state:
  • The authors note that the study was retrospective, that treatments were heterogeneous, and that the sample size was small.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Overall Survival, Progression-Free Survival, Asbestos Exposure, Performance Status, Histology, First-line Therapy.

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