Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients

Our plain-English summary of Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients, by L. Tammilehto, P. Maasilta, S. Kostiainen, et al (Respiration; International Review of Thoracic Diseases, 1992).

The study

• Authors: L. Tammilehto, P. Maasilta, S. Kostiainen, P. Appelqvist, L.R. Holsti, K. Mattson
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 1992;59(3):129-35
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This report is an analysis of the medical records of 83 patients registered between 1960 and 1980 at Helsinki University Central Hospital as having malignant pleural mesothelioma. 65 of 83 patients had histologically confirmed malignant mesothelioma, and are the focus of this analysis. The remaining 18 (22%) patients were excluded because malignant mesothelioma was only confirmed cytologically, or because the primary tumor was not a mesothelioma. The ratio of men to women was 2:1.30 of 65 (46%) patients were not known or not likely to have been exposed to asbestos. The main symptoms at presentation were dyspnea, cough, chest pain, fatigue and weight loss. The median survival from diagnosis was 12 months, and from the onset of symptoms 18 months. Clinical stage and performance status were significant prognostic factors. Hematogenous metastases were present at autopsy in most cases. Disease and performance status therefore need to be well established and documented in clinical trials involving mesothelioma.

In plain English

This was a retrospective review of records at Helsinki University Central Hospital, Finland. Of 83 patients registered between 1960 and 1980 as having malignant pleural mesothelioma, the authors analysed the 65 whose diagnosis was confirmed by tissue examination (43 men, 22 women). Asbestos exposure was judged from occupational histories in the records: 13 patients (20%) had definite or probable exposure, 22 (33%) possible exposure, and 30 (47%) unknown or unlikely exposure. Median survival was 12 months from diagnosis and 18 months from first symptoms. Fourteen patients (21%) were alive two years after diagnosis and 5 (8%) after five years. In the main statistical model, only early (stage I) disease and good performance status (a WHO measure of general functioning) were significantly linked to longer survival. Asbestos exposure was not a significant predictor of survival. Of 18 patients autopsied, 13 (72%) had cancer spread through the bloodstream. The authors concluded that disease stage and performance status need to be well established and documented in clinical trials. They noted that this retrospective analysis could not judge how well treatments worked.

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 analysis of hospital medical records (case series)
• Who was studied: 83 patients registered at Helsinki University Central Hospital, Finland, between 1960 and 1980 as having malignant pleural mesothelioma. The analysis covered the 65 with histologically confirmed malignant mesothelioma (43 men, 22 women; mean age 54 for men and 55 for women).
• Exposure: Asbestos exposure was judged from occupational histories in patient records and grouped into three categories. Definite or probable exposure covered asbestos mining, asbestos product manufacture, asbestos cement, insulation, demolition, shipyards, construction and metal workshops. Possible exposure covered dusty occupations. The third category was unlikely or unknown exposure. No fiber types were reported.
• Main results:
  • Of the 65 patients, 13 (20%) had definite or probable asbestos exposure, 22 (33%) possible exposure, and 30 (47%) were not known or unlikely to have been exposed.
  • Median survival for all 65 patients was 12 months (range 0-86) from diagnosis and 18 months (range 2-105) from onset of symptoms.
  • 14 patients (21%) were alive 2 years after diagnosis and 5 patients (8%) were alive 5 years after diagnosis.
  • In the Cox regression model, only clinical stage I (p = 0.0027) and good performance status, WHO 1 or less (p = 0.0001), contributed significantly to longer survival.
  • Asbestos exposure was not prognostically significant for survival (p = 0.780). The same was true of gender, age, histological subtype, smoking and symptoms.
  • Cytological examination of pleural fluid gave a diagnosis of malignant mesothelioma in 6 of 32 cases (19%).
  • Needle biopsy of the affected pleura revealed malignant mesothelioma in 12 of 28 cases (43%).
  • Among the 18 patients autopsied, hematogenous (bloodstream) metastases were present in 13 (72%) and extrathoracic lymph node metastases in 5 (28%).
• The authors' conclusion: The authors concluded that clinical stage and performance status were significant prognostic factors, so disease status and performance status need to be well established and documented in clinical trials involving mesothelioma.
• Limitations the authors state:
  • Tumor-size staging data (the Dimitrow system) were available for only 32 (49%) patients, so they could not be used in the multivariate survival analysis.
  • Treatment decisions were made without a protocol, so the effectiveness of radiotherapy, chemotherapy or combined treatment could not be evaluated.
  • Pathological subtyping was not routinely used until the later part of the study period. The authors offered this as one possible reason subtype did not predict survival.
  • CT scanning was not routinely available, so disease extent was often estimated by other methods.
  • The younger average age than in other reports could reflect a referral pattern in which only potential treatment candidates were sent to the hospital.

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, Malignant Mesothelioma, Mesothelioma, Dyspnea, Median Survival, Performance Status, Autopsy, Clinical Trial.

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