Malignant mesothelioma, hypoalbuminaemia and the effect of carboplatin/pemetrexed on survival

Our plain-English summary of Malignant mesothelioma, hypoalbuminaemia and the effect of carboplatin/pemetrexed on survival, by S. Murphy, G. Probert, J. Anderson, et al (Clinical Oncology, 2013).

The study

• Authors: S. Murphy, G. Probert, J. Anderson, S. Pollock, I. Taylor, H. Clague, K. Sridharan
• Journal: Clinical Oncology
• Published: 2013;25(12):713-8
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: The incidence of malignant mesothelioma in the UK is increasing. The aim of this study was to determine the prognostic factors and assess the effect of carboplatin/pemetrexed chemotherapy on survival.

Materials And Methods: Cases of malignant mesothelioma diagnosed between 1998 and 2011 were stratified by year of diagnosis. Factors affecting survival were assessed by Cox's proportional hazards regression.

Results: In total, there were 202 new cases of malignant mesothelioma between 1998 and 2011. The age-standardised rate (95% confidence interval) increased from 2.84 (2.06-3.60) to 4.44 (3.50-5.4); P = 0.025. Chemotherapy use has increased since 2006: 52% versus 34% (P = 0.007). The median survival (interquartile range) by year diagnosed was 9 (4.0-21.9) versus 10 (3.8-20.1) months for 1998-2005 versus 2006-2011. Independent predictors of survival [hazard ratio (95% confidence interval)] were: histology, sarcomatoid 2.22 (1.49-3.31) and unspecified non-epithelioid 1.50 (1.06-2.14); Eastern Cooperative Oncology Group performance status ≥3 2.86 (1.64-5.00); hypoalbuminaemia 2.07 (1.47-2.92), carboplatin/pemetrexed chemotherapy 0.56 (0.38-0.80).

Conclusion: The incidence of mesothelioma is increasing. Adverse prognostic factors include non-epithelioid histology, performance status and hypoalbuminaemia. Overall survival has not improved significantly, but treatment with carboplatin/pemetrexed chemotherapy is associated with a significant survival benefit.

Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This retrospective study reviewed 202 mesothelioma patients (96.5% pleural) diagnosed at Sunderland Royal Hospital, UK, in 1998 to 2011; asbestos exposure was not examined. The five-year average age-standardised rate per 100,000 rose from 2.84 (95% confidence interval 2.06 to 3.60) in 1998 to 2002 to 4.44 (3.50 to 5.4) in 2007 to 2011. Chemotherapy use rose from 34% in 1998 to 2005 to 52% in 2006 to 2011, when carboplatin/pemetrexed was the only regimen. Median survival did not differ significantly between the periods: 9 versus 10 months. In multivariate analysis, shorter survival was linked with three factors. These were hypoalbuminaemia (low blood albumin) at diagnosis (hazard ratio 2.07, confidence interval 1.47 to 2.92), and sarcomatoid (2.22, 1.49 to 3.31) or unspecified non-epithelioid tumours (1.50, 1.06 to 2.14) versus epithelioid. The third was ECOG performance status 3 to 4 versus 0 to 1 (2.86, 1.64 to 5.00). Carboplatin/pemetrexed, versus best supportive care or other regimens, was linked with longer survival (0.56, 0.38 to 0.80). The authors concluded that overall survival had not improved significantly, but that carboplatin/pemetrexed was associated with a significant survival benefit.

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 study of hospital patients (survival analysis using Kaplan-Meier and Cox proportional hazards regression)
• Who was studied: 202 new cases of mesothelioma diagnosed at Sunderland Royal Hospital, Sunderland, UK, from 1 January 1998 to 31 December 2011. Of these, 96.5% were pleural and 3.5% peritoneal; 81.6% were male, and the median age at diagnosis was 69 years. Most diagnoses were confirmed by histology, and some were made by consensus of the multidisciplinary team.
• Exposure: Not asbestos exposure. The study examined chemotherapy, mainly carboplatin/pemetrexed (69 patients, median six cycles), against best supportive care or other regimens. It also examined clinical and laboratory factors at diagnosis such as serum albumin, ECOG performance status and tumour histology.
• Main results:
  • The age-standardised rate (per 100,000 European standard population, averaged over 5 years) rose from 2.84 (95% CI 2.06 to 3.60) in 1998 to 2002 to 4.44 (3.50 to 5.4) in 2007 to 2011; P = 0.025.
  • Chemotherapy use rose from 34% of patients (1998 to 2005) to 52% (2006 to 2011); P = 0.007.
  • Median survival was 9 (interquartile range 4.0 to 21.9) months for patients diagnosed in 1998 to 2005 and 10 (3.8 to 20.1) months for those diagnosed in 2006 to 2011. The difference was not significant (P = 0.69). Overall median survival was 10 months.
  • At diagnosis, 41.0% of patients had hypoalbuminaemia (albumin below 35 g/l) and 57.4% were anaemic.
  • In the multivariate analysis, several factors were independently associated with worse survival. These were ECOG performance status 3 to 4 versus 0 to 1 (hazard ratio 2.86, 95% CI 1.64 to 5.00), hypoalbuminaemia (2.07, 1.47 to 2.92), sarcomatoid histology versus epithelioid (2.22, 1.49 to 3.31) and unspecified non-epithelioid histology versus epithelioid (1.50, 1.06 to 2.14). Carboplatin/pemetrexed chemotherapy was associated with better survival (0.56, 0.38 to 0.80).
  • Among patients with ECOG score 0 to 2 and normal serum albumin, median survival was 20 (12.0 to 40.9) months for those treated with carboplatin/pemetrexed (n = 54). It was 12 (4.7 to 22.7) months for those given no chemotherapy or another regimen (n = 50); P = 0.022.
  • Ten patients with sarcomatoid mesothelioma treated with carboplatin/pemetrexed survived a median of 10 (7.4 to 12.8) months, compared with 3 (1.1 to 5.4) months for other sarcomatoid patients; P = 0.041.
  • There was no difference in survival between men and women, and age was not an independent predictor of survival.
• The authors' conclusion: The authors concluded that mesothelioma incidence is increasing and that non-epithelioid histology, performance status and hypoalbuminaemia are adverse prognostic factors. They also concluded that overall survival has not improved significantly, but that carboplatin/pemetrexed chemotherapy is associated with a significant survival benefit.
• Limitations the authors state:
  • Data were missing, particularly for performance status, and were replaced by imputation (ECOG score in 35% of cases, Charlson Comorbidity Index in 41%).
  • The retrospective design created potential for selection bias, because patients given chemotherapy had better prognostic indicators at diagnosis. The authors addressed this through multivariate analysis.
  • Treatment-related adverse effects and quality of life were not assessed.
  • Other treatments, such as surgical procedures and radiotherapy, were not included in the analysis.

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: Mesothelioma, Carboplatin, Pemetrexed (Alimta), Chemotherapy, confidence interval, Median Overall Survival, Hazard Ratio, Histology.

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