Factors influencing long-term survival in mesothelioma patients--results of the German mesothelioma register

Our plain-English summary of Factors influencing long-term survival in mesothelioma patients--results of the German mesothelioma register, by V. Neumann, A. Rütten, M. Scharmach, et al (International Archives of Occupational and Environmental Health, 2004).

The study

• Authors: V. Neumann, A. Rütten, M. Scharmach, K.M. Müller, M. Fischer
• Journal: International Archives of Occupational and Environmental Health
• Published: 2004;77(3):191-9
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Between 1987 and 2000, the German mesothelioma register recorded a total of 4,455 patients with malignant mesotheliomas. Survival times for 498 (11.2%) patients were available; 155 patients (study group, 3.5% of the total group) survived for more than 2 years and 343 patients (control group, 7.7% of the total group) survived for fewer than 24 months. Male patients were over-represented in both groups, with 13% of women in the study and 4.4% in the control group. The proportion of pleural mesotheliomas was more than 90% in both groups, with peritoneal cases comprising 6.5% in the study group and 3.2% in the control group. Histologically, the epithelioid subtype was represented in 58% of the study group, whereas the biphasic subtype predominated (67.6%) in the control group. Only 7% of tumours were of the sarcomatoid subtype. The average age of patients in the study group was 57.4 years, thus lower than in the control group (62.8 years). Lung dust analysis showed an increased pulmonary asbestos burden in 94% of all patients; significant differences between the study and control group were not observed. In the majority of the total group pleural effusions were the first symptoms. Therapeutic data were available in fewer than 40% of all cases. Surgical interventions were performed, partly in combination with radiation and chemotherapy and as alternative treatments. Significant deviations in survival time dependent on therapy applied could not be proved. By multivariate analysis (Cox proportional hazards regression model) favourable prognostic factors for long-term survival were epithelioid tumour subtype, comparatively young age (<60 years), and female gender ( P<0.05).

In plain English

This study used German mesothelioma register records of 4,455 patients with malignant mesothelioma from 1987 to 2000. Survival times were known for only 498. The authors compared 155 patients who survived more than 24 months with 343 who survived less. Long survivors were younger at diagnosis (average 57.4 versus 62.8 years), more often women (13% versus 4.4%), and more often had the epithelioid tumour subtype (58.1% versus 22.7%). Average survival was 48.1 months in the long-survivor group and 8.7 months in the other group. In a multivariate analysis, sarcomatoid subtype (hazard ratio 1.89), male gender (1.72) and age over 60 (1.29) were linked to poorer survival. Raised lung asbestos body counts were found in 93% and 95.5% of the two groups' patients with usable tissue. The difference was not significant. The authors wrote that their study suggests the level of asbestos exposure cannot be regarded as a prognostic factor. Treatment data covered fewer than 40% of patients and mostly lacked tumour stage. No link between treatment and survival was seen; the authors said the data permitted no evaluation of therapies.

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 mesothelioma register records, comparing patients who survived more than 24 months with those who survived less than 24 months
• Who was studied: Of 4,455 patients with malignant mesothelioma recorded by the German mesothelioma register between 1987 and 2000, the 498 with known survival times: 155 who survived more than 24 months (study group) and 343 who survived less than 24 months (control group)
• Exposure: Pulmonary asbestos burden, measured as asbestos bodies per cubic centimetre of lung tissue by light microscopy, in lung tissue from 69 study-group and 343 control-group patients. A burden above 22 asbestos bodies per cubic centimetre was counted as increased. Fiber types were not reported.
• Main results:
  • Average age at diagnosis was 57.4 years in the study group (n=155), compared with 62.8 years in the control group. The study group was significantly younger.
  • The study group included 20 women (13%) and 135 men. The control group included 15 women (4.4%) and 328 men.
  • The epithelioid subtype made up 58.1% (90 of 155) of the study group and 22.7% (78 of 343) of the control group. Epithelioid tumours predominated in the study group in both sexes and in both pleural and peritoneal mesothelioma.
  • Average survival was 48.1 months in the study group and 8.7 months in the control group.
  • In a multivariate Cox model of all 498 patients, three factors were poor prognosis factors: sarcomatoid subtype (hazard ratio 1.89; P=0.001), male gender (hazard ratio 1.72; P=0.01) and age over 60 years (hazard ratio 1.29; P=0.01).
  • Among patients with representative lung tissue (57 study group, 310 control group), an increased asbestos burden was found in 93% of the study group and 95.5% of the control group. The difference was not significant, and no correlation was found between asbestos burden and survival time.
  • Pleural effusion was the first symptom of pleural mesothelioma in 90 of 109 study-group patients (82.6%) and 144 of 183 control-group patients (78.7%) with available data.
  • Among pleural mesothelioma patients with therapy data (77 study group, 87 control group), no correlation was seen between type of therapy and survival time.
• The authors' conclusion: The authors wrote that their study suggests the level of asbestos exposure cannot be regarded as a prognostic factor for survival. They also said that, because of insufficient data, their results permit no evaluation of the success or failure of therapies.
• Limitations the authors state:
  • Survival times were missing for most registered patients and could not be recorded in retrospect, so the true proportion of long survivors might be higher.
  • Therapy information existed for fewer than 40% of patients, and tumour stage, drugs and radiation doses were mostly missing.
  • The patients were not a randomised group.
  • The excess of epithelioid tumours in the study group may partly reflect sample size. Small biopsies made up 58.4% of the study group and 10.5% of the control group.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Pleural Mesothelioma, Epithelioid, Biphasic Mesothelioma, Sarcomatoid, Pleural Effusion, Chemotherapy.

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