Diffuse malignant mesothelioma. Prospective evaluation of 69 patients

Our plain-English summary of Diffuse malignant mesothelioma. Prospective evaluation of 69 patients, by A.P. Chahinian, T.F. Pajak, J.F. Holland, et al (Annals of Internal Medicine, 1982).

The study

• Authors: A.P. Chahinian, T.F. Pajak, J.F. Holland, L. Norton, R.M. Ambinder, E.M. Mandel
• Journal: Annals of Internal Medicine
• Published: 1982;96(6 Pt 1):746-55
• Cited by: 292 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000663).

Abstract

From 1974 to 1980, 69 patients with ith diffuse malignant mesothelioma were prospectively evaluated. The initial site of involvement was the pleura in 57 patients and the peritoneum in 12. Previous asbestos exposure was found in 53 patients (77%), with a shorter period of latency for peritoneal (mean, 28 years) than for ith pleural mesothelioma (mean, 35 years) than for pleural mesothelioma (mean, 35 years). Other associated exposure or diseases included talc, mica, familial Mediterranean fever, and diffuse lymphocytic lymphoma (one patient each). Thrombocytosis was common, as were thromboembolic episodes. Survival was significantly better for patients with an epithelial subtype, with pleural versus peritoneal mesothelioma, and for those under 65 years of age. Surgery was never curative, but its extent was correlated with survival and earlier diagnosis. Results of chemotherapy with doxorubicin and 5-azacytidine yielded a somewhat better survival rate than a combined program with doxorubicin and radiotherapy. Survival after chemotherapy was correlated with performance status, response to chemotherapy, and extent of previous surgery.

In plain English

This prospective study evaluated 69 patients with diffuse malignant mesothelioma at Mount Sinai Medical Center, New York, from 1974 to 1980: 57 with pleural and 12 with peritoneal disease. Fifty-three patients (77%) had a history of asbestos exposure. For 44 it was occupational (shipyards, insulation and building construction, the asbestos industry). Seven more, all pleural cases, were exposed indirectly, through their environment or family. The study did not report which asbestos fiber types the patients encountered. First exposure preceded diagnosis by a mean of 35 years for pleural and 28 years for peritoneal mesothelioma (p = 0.007); the authors said the peritoneal group was too small for a definite conclusion. Median survival from diagnosis was 12.9 months (pleural) and 7.0 months (peritoneal). Epithelial cell type, age below 65 and pleural site were associated with longer survival. Surgery was never curative. In pleural patients, median survival from diagnosis was 20.0 months with doxorubicin and 5-azacytidine versus 12.5 months with doxorubicin plus radiotherapy (p = 0.29). The authors concluded that encouraging results from systemic therapy could be obtained even at a late stage.

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: Prospective clinical series of patients evaluated and treated at one cancer department, with two treatment protocols evaluated one after the other (1974 to 1976, then 1976 to 1980)
• Who was studied: 69 patients with diffuse malignant mesothelioma at the Department of Neoplastic Diseases, Mount Sinai Medical Center, New York, 1974 to 1980: 57 with pleural and 12 with peritoneal mesothelioma. The ratio of men to women was 3.6 to 1.
• Exposure: Asbestos exposure taken from patient histories. Occupational exposure in 44 patients: shipyard construction or repairs (17), insulation and building construction (14), asbestos industry (13). Indirect exposure in 7 more: environmental (3) and familial (4). Other exposures were cosmetic talc (1 patient) and mica (1 patient). The asbestos fiber types the patients were exposed to were not reported.
• Main results:
  • 53 of 69 patients (77%) had a history of asbestos exposure: 47 with pleural and 6 with peritoneal mesothelioma.
  • Asbestos exposure was significantly more frequent in men than in women (89% versus 33%, p less than 0.001).
  • Seven additional patients, all with pleural mesothelioma, were indirectly exposed: environmentally in three (they lived near an asbestos plant) and through family in four (their father's work clothes).
  • The interval from first asbestos exposure to diagnosis averaged 35 years for pleural mesothelioma (range 20 to 50) and 28 years for peritoneal mesothelioma (range 10 to 35). The interval was significantly shorter for peritoneal cases (p = 0.007).
  • No peritoneal mesothelioma in the series arose from environmental or familial exposure. The authors called this consistent with the suggestion that heavier asbestos exposure may cause peritoneal rather than pleural mesothelioma.
  • Pleural mesothelioma (57 patients): median survival was 17.3 months from first symptom and 12.9 months from histologic diagnosis.
  • Peritoneal mesothelioma (12 patients): median survival was 10.0 months from first symptom and 7.0 months from diagnosis.
  • In multivariate analysis of survival from diagnosis, three factors were favorable: epithelial cell type (p = 0.005), age below 65 years (p = 0.026), and pleural site (p = 0.040).
  • Radical surgery (6 pleural patients) was never curative, but median survival from diagnosis in this group was 18 months.
  • Pleural patients given doxorubicin and 5-azacytidine (28 patients): objective responses in 7 (2 complete, 5 partial). Survival from diagnosis was 68% at 1 year and 35% at 2 years, with a median of 20.0 months.
  • Pleural patients given doxorubicin and radiotherapy (14 patients): median survival was 12.5 months from diagnosis and 10 months from first treatment.
  • The survival comparison between the two treatment types gave p = 0.29.
  • Survival from first chemotherapy was correlated with type of response (p less than 0.001), initial performance status (p less than 0.001), and extent of previous surgery (p = 0.007).
  • Thrombocytosis (platelet count above 400,000 per cubic millimeter) occurred in 62 patients (90%) during the course of the disease.
• The authors' conclusion: The authors concluded that encouraging results from systemic therapy could be obtained even at a late stage of the disease.
• Limitations the authors state:
  • The authors said there were too few peritoneal mesothelioma patients to reach a definite conclusion about the shorter latency period.
  • The authors noted that the number of peritoneal cases was small when comparing occupational histories between pleural and peritoneal cases.
  • About half of the patients lacked clearly defined measurable disease, which the authors said made response measurement difficult.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Peritoneum, Asbestos Exposure, Latency, Pleural Mesothelioma, Talc, Mica.

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