Early-stage Clinical Characterization of Malignant Pleural Mesothelioma

Our plain-English summary of Early-stage Clinical Characterization of Malignant Pleural Mesothelioma, by Y. Negi, K. Kuribayashi, N. Funaguchi, et al (In Vivo, 2018).

The study

• Authors: Y. Negi, K. Kuribayashi, N. Funaguchi, H. Doi, K. Mikami, T. Minami, T. Takuwa, T. Yokoi, S. Hasegawa, T. Kijima
• Journal: In Vivo
• Published: 2018;32(5):1169-1174
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/aim: A strategy for improving survival of malignant pleural mesothelioma (MPM) patients is earlier diagnosis paired with earlier stage implementation of therapeutic interventions. This study aimed to determine the clinical signs of early-stage MPM to aid an earlier diagnosis and earlier-stage intervention.

Materials And Methods: Out of the 72 cases in our institution, 40 cases with 18F-FDG-PET/CT-negative MPM were retrospectively identified between 2007 and 2015. Overall survival rates were determined and compared with pathological features, histology, and treatment.

Results: The biphasic histological type of early-stage MPM was characterized by poor prognosis (p=0.0006). Additionally, the cytology-negative group (Class III and below) showed significantly shorter survival times (p=0.0290). There was no significant difference in survival between patients who received pleurectomy and those who received chemotherapy only (p=0.6991). Bimodal therapy resulted in a longer survival rate than trimodal therapy.

Conclusion: In early-stage PET-negative MPM cases, biphasic histology and pleural effusion of Class III and below correlated with a poor prognosis. Surgical treatment using pleurectomy/decortication resulted in higher patient survival outcomes than therapy with extrapleural pneumonectomy.

Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

In plain English

This retrospective study reviewed malignant pleural mesothelioma cases diagnosed between April 2007 and December 2015 at Hyogo College of Medicine in Japan. Of 72 cases, the 40 without significant uptake on FDG-PET scans were treated as early-stage cases. The authors listed asbestos exposure among the patient characteristics they analysed but reported no results on it. Median survival was 1383 days for the PET-negative group and 811 days for the PET-positive group, which was not a statistically significant difference. Among the 40 early-stage cases, the three with biphasic tumours had a median survival of 385 days, against 1,383 days for the 37 with epithelioid tumours. Patients with Class II or III pleural fluid cytology had shorter median survival (596 days) than those with Class IV or V (1805 days). Survival did not differ significantly between surgery and no surgery overall. The five patients given trimodality therapy including extrapleural pneumonectomy had a median survival of 432 days, shorter than patients who did not have this operation. The authors concluded that pleurectomy/decortication gave better survival than extrapleural pneumonectomy.

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 single-institution study of pathology-confirmed cases, using Kaplan-Meier survival analysis
• Who was studied: 72 pathology-confirmed malignant pleural mesothelioma cases diagnosed between April 2007 and December 2015 at Hyogo College of Medicine, Japan, all N0, M0. They were split into 32 PET-positive cases (SUV 2.5 or higher) and 40 PET-negative cases. The 40 PET-negative cases served as the early-stage group. Their median age was 70 years (range 51 to 83).
• Exposure: Asbestos exposure status was listed as a characteristic that was analysed, but no asbestos results are reported. The factors actually compared with survival were PET status, T-stage, age, histological type, pleural effusion cytology and treatment: trimodality therapy with extrapleural pneumonectomy, bimodality therapy with pleurectomy/decortication, chemotherapy alone, or best supportive care.
• Main results:
  • PET-positive versus PET-negative groups: median overall survival was 811 days versus 1383 days. The difference was not statistically significant (p=0.2356), though the authors describe a trend towards longer survival in the PET-negative group.
  • Among the 40 PET-negative cases, 22 were T1a and 18 were T1b. Survival did not differ significantly between them (1,383 versus 1,307 days, p=0.8844).
  • Among the 40 PET-negative cases, 37 (92.5%) were epithelioid and 3 (7.5%) were biphasic. No sarcomatoid cases were seen. Median overall survival was 385 days for biphasic and 1,383 days for epithelioid (p<0.001).
  • All 40 PET-negative cases had pleural effusion. Cytology classes were: Class II, 3; Class III, 6; Class IV, 7; Class V, 24. The cytology-negative group (Class II/III, 9 cases) had a median survival of 596 days. The cytology-positive group (Class IV/V) had 1805 days (p<0.05). Of the 9 cytology-negative cases, 8 were in the non-surgery group and 2 were biphasic.
  • Median overall survival by treatment group: trimodality (with extrapleural pneumonectomy, 5 cases) 432 days; bimodality (pleurectomy/decortication, 8 cases) not available; chemotherapy alone (20 cases) 1218 days; best supportive care (5 cases) 1823 days.
  • Survival did not differ significantly between the surgery group (extrapleural pneumonectomy or pleurectomy/decortication) and the non-surgery group (p=0.6991).
  • The non-EPP group (pleurectomy/decortication, chemotherapy and best supportive care) had longer median survival than the extrapleural pneumonectomy group (432 days), with p<0.05. The Discussion gives these as 46.1 months versus 14.4 months. It also reports a 3-year postoperative survival rate of 60% in the extrapleural pneumonectomy group.
• The authors' conclusion: The authors concluded that even in early-stage malignant pleural mesothelioma, biphasic histology, extrapleural pneumonectomy and negative cytology were associated with poor prognosis. They also concluded that pleurectomy/decortication gave better survival than extrapleural pneumonectomy, and that treatments for early-stage disease need very careful selection.
• Limitations the authors state:
  • The authors state that post-diagnosis treatment may explain why survival did not differ significantly between the PET-positive and PET-negative groups.
  • The authors note that the cytology-negative group included 2 of the 3 biphasic cases and that 8 of its 9 cases had no surgery. Its shorter survival may therefore reflect differences in treatment.

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, Overall Survival, Histology, Biphasic Mesothelioma, Prognosis, Cytology, Chemotherapy, Pleural Effusion.

Related studies

• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma — S. Kanemura, K. Kuribayashi, et al. (2017)
• Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma — P. Bertoglio, M.C. Ambrogi, et al. (2017)
• Is There a Role for Cancer-Directed Surgery in Early-Stage Sarcomatoid or Biphasic Mesothelioma? — S. Kim, D.A. Bull, et al. (2019)
• Adenosine Deaminase in Pleural Effusion and Its Relationship with Clinical Parameters in Patients with Malignant Pleural Mesothelioma — Y. Nakajima, K. Kuribayashi, et al. (2020)
• miR-1254 and miR-574-5p: serum-based microRNA biomarkers for early-stage non-small cell lung cancer — K.M. Foss, C. Sima, et al. (2011)

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