Clinicopathologic and survival characteristics of malignant pleural mesothelioma registered in hospital cancer registry

Our plain-English summary of Clinicopathologic and survival characteristics of malignant pleural mesothelioma registered in hospital cancer registry, by K. Najmi, A. Khosravi, S. Seifi, et al (Tanaffos, 2014).

The study

• Authors: K. Najmi, A. Khosravi, S. Seifi, H. Emami, S. Chaibakhsh, G. Radmand, K. Khodadad
• Journal: Tanaffos
• Published: 2014;13(2):6-12
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare but fatal thoracic tumor, which in the majority of patients is caused by prolonged exposure to asbestos fibers. We aimed at presenting clinicopathological and treatment outcomes of 60 patients of MPM registered in our hospital cancer registry.

Materials And Methods: Demographic characteristics of patients, exposure to asbestos, smoking habit, their clinicopathologic characteristics and survival analysis were described.

Results: Sixty patients had MPM. Forty patients (66.7%) were men. The mean age of patients was 55.8±11 years. Chest pain and dyspnea were the most prevalent symptoms (31.7%, and 30%, respectively). Thirty-six (61.7%) patients reported asbestos exposure. The median survival and Progression free survival (PFS) were 10.5 months (0.95CI=9.22-11.78) and 7.57 months (0.95CI=5.68-9.45), respectively. In multivariate analysis, exposure to asbestos and epithelioid subtype significantly extended the survival time. Bilateral involvement, high blood level of LDH and platelet count ≥400,000 significantly shortened the overall survival.

Conclusion: MPM is still an important health problem in Iran. Given the aforementioned results, developing a national program to eliminate asbestos-related diseases according to the world health organization (WHO) recommendation is necessary.

In plain English

This chart review studied 60 patients with malignant pleural mesothelioma recorded from 2010 to 2013 in the hospital cancer registry of Masih Daneshvari Hospital in Iran. They were 60 of 600 thoracic cancers registered. Forty were men, the mean age was 55.8 years, and 49 had stage IV disease. About 61.7% reported past asbestos exposure that was occupational, environmental or both. The text gives this as 36 patients and the table as 37. Median overall survival was 10.5 months (95% confidence interval 9.22 to 11.78), median progression-free survival was 7.57 months (5.68 to 9.45), and 45 patients died. Looking at one factor at a time, only platelet count made a significant difference: 10.8 months for counts under 400,000 versus 7.4 months for higher counts. In the multivariable analysis, reported asbestos exposure and the epithelioid subtype were associated with longer survival. Bilateral disease, higher LDH and platelet counts of 400,000 or more were associated with shorter survival. The authors suggested the exposure finding might reflect earlier diagnosis and called for larger studies.

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 chart review of a hospital-based cancer registry, with Kaplan-Meier and Cox proportional hazards survival analysis
• Who was studied: 60 patients with malignant pleural mesothelioma (10% of 600 thoracic malignancies) registered 2010 to 2013 at Masih Daneshvari Hospital, Tehran, Iran. 40 men; mean age 55.8 years (range 34 to 79); 49 (81.7%) had stage IV disease.
• Exposure: Patient-reported history of occupational or environmental asbestos exposure; no fiber types named. Among exposed patients: 12 occupational, 12 environmental, 13 both. Average exposure 36.1 years.
• Main results:
  • All 60 patients: median overall survival 10.5 months (95% CI 9.22 to 11.78).
  • All 60 patients: median progression-free survival 7.57 months (95% CI 5.68 to 9.45).
  • 45 of the 60 patients (75%) had died (Table 1).
  • In univariate analysis only platelet count was significant: median survival 10.8 months with platelet count below 400,000 vs 7.4 months with 400,000 or more (p less than 0.05).
  • Multivariate analysis: reported asbestos exposure was associated with longer survival (HR 0.194, 95% CI 0.072 to 0.522). In univariate analysis it was not significant (HR 0.577, 0.310 to 1.073).
  • Multivariate analysis: epithelioid subtype was associated with longer survival (HR 0.121, 95% CI 0.017 to 0.881).
  • Multivariate analysis: bilateral involvement was associated with shorter survival (HR 9.486, 95% CI 2.466 to 36.485).
  • Multivariate analysis: higher LDH was associated with shorter survival (HR 1.006 per unit increase, 95% CI 1.001 to 1.011).
  • Multivariate analysis: platelet count of 400,000 or more was associated with shorter survival (HR 3.523, 95% CI 1.212 to 10.237).
  • Pemetrexed plus carboplatin vs gemcitabine plus carboplatin: 26.3 vs 10.3 months. The authors reported this difference as not statistically significant (p = 0.056).
  • The 6 patients (10%) given multimodality therapy lived longer: 22.7 vs 10.3 months. No significance test is reported.
• The authors' conclusion: The authors concluded that epithelial subtype, asbestos exposure, platelet count below 400,000 and unilateral involvement confer better overall survival. They concluded that a national programme to eliminate asbestos exposure and asbestos-related diseases, following WHO recommendations, seems necessary. They speculated that the environment is potentially an important source of exposure.
• Limitations the authors state:
  • Small sample size, offered by the authors as a possible reason some differences (chemotherapy regimen, stage, sex) were not statistically significant.
  • The authors stated that larger studies are needed to validate the findings.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Cancer Registry, Habit, Dyspnea, Asbestos Exposure, Median Survival, Multivariate Analysis, Epithelioid.

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