Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study

Our plain-English summary of Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study, by L. Saracino, C. Bortolotto, S. Tomaselli, et al (BMC Cancer, 2021).

The study

• Authors: L. Saracino, C. Bortolotto, S. Tomaselli, E. Fraolini, M. Bosio, G. Accordino, F. Agustoni, D.M. Abbott, E. Pozzi, D. Eleftheriou, P. Morbini, P. Rinaldi, C. Primiceri, A. Lancia, P. Comoli, A.R. Filippi, G.M. Stella
• Journal: BMC Cancer
• Published: 2021;21(1):762
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural layers. MPM has a strong association with asbestos, mainly caused by exposure to its biopersistent fibers in at least 80% of cases. Individuals with a chronic exposure to asbestos might develop disease with a 20-40-year latency with few or no symptoms. Such has been the case in the Italian regions of Piedmont and Lombardy, where industrial production of materials laden with asbestos, mainly cements, has been responsible for the onset of a large epidemic. Since 2018, a multidisciplinary team at San Matteo hospital in Pavia has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis.

Methods: Here we bring together exhaustive epidemiologic, histologic and radiologic data of 88 MPM patients that came to our observation and draw correlations with predictive and prognostic significance.

Results: The median overall survival (OS) was 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association was demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In females with no smoking history, full chemotherapeutic regimens are associated with better outcomes. Moreover, concerning second line treatments, vinorelbine emerged as the most advantageous choice for female patients, whereas in the male subgroup no statistically significant difference resulted between gemcitabine and vinorelbine.

Conclusion: A multidisciplinary approach to MPM is mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.

In plain English

This cohort study from Pavia, in the Lombardy region of Italy, analyzed 88 patients with malignant pleural mesothelioma managed by a multidisciplinary hospital program between November 2018 and May 2020 (62 men, 26 women). Of the 88, 26 reported certain or highly probable workplace asbestos exposure, 32 environmental or indirect exposure, and 30 no relevant exposure. Fiber types were not reported. The authors combined clinical, tissue and imaging data and used a decision-tree ('partition') analysis to look for factors linked to survival. Average overall survival was 15.6 months: 18.2 months in women and 14.6 in men. Survival was not significantly associated with tumor stage. Women who received second-line treatment had longer average survival than those who did not (22.4 vs 12.5 months). In men, platinum plus pemetrexed was associated with longer survival than platinum alone (15.4 vs 11.4 months). In women, second-line vinorelbine was associated with significantly different survival compared with gemcitabine, which the authors called a slight advantage. In men the difference was not statistically significant. The authors said a wider set of data is needed to rule out a statistical fluctuation.

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: Cohort study of patients managed through a hospital mesothelioma program, analyzed with Kaplan-Meier survival curves and a decision-tree (partition) data-mining analysis
• Who was studied: 88 patients with malignant pleural mesothelioma (62 men, 26 women) managed by the territorial program of IRCCS Policlinico San Matteo, Pavia, and the Broni clinic, Italy, between November 2018 and May 2020. Of 105 patients referred, 17 did not meet the inclusion criteria. Average age at diagnosis was 68.9 years (range 47 to 85).
• Exposure: Self-reported asbestos exposure history, grouped as workplace (26 patients, certain or highly probable), environmental or indirect, including relatives of asbestos plant workers (32), or none (30). Fiber types were not specified. The authors also recorded smoking history (36 never, 15 active, 37 former smokers).
• Main results:
  • Environmental or indirect asbestos exposure was reported by 32 of the 88 patients (36.4%).
  • No relevant asbestos exposure history was reported for 30 of the 88 patients (34%).
  • Pleural effusion was present in 96% of the 88 patients (84 patients). The authors described this as higher than previously published data.
  • Most patients (66 of 88, 75%) had epithelioid mesothelioma. Epithelioid cases had longer overall survival (15.72 months) than sarcomatoid (13.2 months) and biphasic (11.8 months) cases.
  • For the whole cohort of 88, average overall survival was 15.6 months, irrespective of tumor histotype.
  • Mean overall survival was 18.2 months in women and 14.6 months in men.
  • There was no significant correlation between TNM disease stage at diagnosis and overall survival.
  • In women, the variable most associated with overall survival was access to second-line treatment. Women who did not receive it had significantly lower overall survival (12.5 months) than those who did (22.4 months).
  • Among women who received second-line treatment, those with a past or current smoking history had an average overall survival of 18.7 months. Women who never smoked and received comprehensive chemotherapy had a mean overall survival of 25.6 months.
  • In men, first-line platinum plus pemetrexed was associated with longer overall survival (15.4 months) than platinum alone (11.4 months).
  • In men, advanced disease stage was associated with a mean overall survival of 5 months.
  • In both men and women, no significant differences in progression-free survival were found between chemotherapy regimens.
  • Second-line treatment compared gemcitabine (30 patients) with vinorelbine (19 patients). In women, overall survival differed significantly with vinorelbine compared with gemcitabine (described as a 'moderate significant difference'). In men the difference was not statistically significant. No survival figures or p-values for these groups are given in the text.
  • 52 of the 88 patients (59.1%) received some form of surgery: 46 had pleurectomy/decortication and 6 had other palliative surgery.
• The authors' conclusion: The authors concluded that their preliminary results suggest an extensive chemotherapy program for patients with acceptable performance status and limited disease stage. They reported a slight advantage of vinorelbine over gemcitabine as second-line chemotherapy in women. They said multidisciplinary management should help identify patients who can benefit from a more aggressive drug approach, and that TNM staging is likely inadequate on its own.
• Limitations the authors state:
  • The authors said a wider set of data is needed to confirm the findings and to exclude a statistical fluctuation as the explanation for the observed correlations.
  • No conclusions could be drawn about radiotherapy because few patients received it (7 of 88).
  • Side effects of chemotherapy were not specifically monitored.
  • The authors acknowledged that several limitations affect the analyzed cohort, without listing them.

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, Cohort Study, Latency, Multidisciplinary Team, Median Overall Survival, Pleural Effusion, Vinorelbine, Gemcitabine.

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