Effects of combined therapies on the survival of pleural mesothelioma patients treated in Brescia, 1982-2006

Our plain-English summary of Effects of combined therapies on the survival of pleural mesothelioma patients treated in Brescia, 1982-2006, by P.G. Barbieri, A. Marinaccio, P. Ferrante, et al (Tumori, 2012).

The study

• Authors: P.G. Barbieri, A. Marinaccio, P. Ferrante, A. Scarselli, V. Pinelli, G. Tassi
• Journal: Tumori
• Published: 2012;98(2):215-9
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department.

Methods: The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors.

Results: The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982-2000 and 2001-2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy).

Conclusions: This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis - even if modest--on larger numbers of patients and taking into account the different stages of the disease.

In plain English

This study looked at survival among 530 people diagnosed with malignant pleural mesothelioma from 1982 to 2006 and treated at one hospital in Brescia, northern Italy. Of these, 343 lived in Brescia province and 187 came from elsewhere, and vital status was followed to 31 December 2009. The article did not report or analyze the patients' own asbestos exposure. The study compared treatments recorded in hospital files. Just over half the patients (59.8%) received only palliative care. Median survival for the whole group was 317 days. After adjustment for other factors, patients given chemotherapy alone or surgery alone did not survive significantly longer than those given symptomatic care. Compared with symptomatic care, the relative risk of death was 0.57 (confidence interval 0.40-0.81) for combined treatments and 0.61 (0.37-0.99) for multimodal therapy. Older age and biphasic or fibrous tumor types were linked to a higher risk of death. The authors concluded that combination therapies appeared to significantly improve survival, though it remained poor. They noted that disease stage could not be analyzed and that healthier patients may have been chosen for treatment.

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: Hospital-based survival analysis of a case series (not prospective, not population-based), using Kaplan-Meier and Cox regression methods
• Who was studied: 530 patients with malignant pleural mesothelioma diagnosed 1982-2006, all treated at the Brescia hospital (Lombardy, Italy): 343 residents of Brescia province and 187 from outside the province; vital status followed to 31 December 2009
• Exposure: The patients' own asbestos exposure was not reported or analyzed in this article. The introduction says only that the disease is causally associated with asbestos exposure. The factors compared were treatments, grouped into six categories: palliative/symptomatic therapy (317 patients), chemotherapy (53), surgery (37), immunotherapy (57), combined bi- or tri-modality approaches (42), and multimodality approach, meaning extra-pleural pneumonectomy plus chemotherapy plus radiotherapy (24)
• Main results:
  • Median survival for all 530 patients was 317 days: 257 days for Brescia residents and 398 days for non-residents
  • Survival was significantly longer for non-residents than residents; the authors described non-residents as a selected group of generally younger patients with earlier-stage cancer
  • 59.8% of patients received only palliative therapies
  • In the adjusted Cox model, single treatments showed no significant benefit over symptomatic care (chemotherapy RR 0.95, 0.69-1.32; surgery RR 0.84, 0.59-1.20). Combined therapy (RR 0.57, 0.40-0.81) and multimodality therapy (RR 0.61, 0.37-0.99) were linked to significantly longer survival
  • Immunotherapy's effect varied over time: a short-term survival advantage, but over the longer period shorter survival and a significantly higher risk of death
  • Compared with patients aged 55 or under, risk of death was significantly higher at ages 66-75 (RR 1.47, 1.11-1.95) and over 75 (RR 1.91, 1.33-2.51)
  • Compared with epithelioid tumors, risk of death was higher for fibrous (RR 3.02, 2.07-4.40) and biphasic (RR 1.62, 1.24-2.11) types
  • Patients with only a 'possible' (clinical) diagnosis had a median survival of only 56 days
• The authors' conclusion: The authors concluded that combination therapies, including multimodality treatments, appeared to significantly improve survival, although survival was still poor. They said confirmation is needed in larger groups of patients, with analysis of disease stage
• Limitations the authors state:
  • Clinical stage of disease could not be analyzed because staging was available for only about 25% (1982-2000) and about 50% (2001-2006) of cases
  • The study was not prospective or population-based, and the case group was heterogeneous
  • Possible selection bias: patients in better general health were considered eligible for therapy

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, Chemotherapy, Immunotherapy, Prognosis, Median Overall Survival, Multivariate Analysis, Epithelioid, Palliative Care.

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