Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985

Our plain-English summary of Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985, by K. Antman, R. Shemin, L. Ryan, et al (Journal of Clinical Oncology, 1988).

The study

• Authors: K. Antman, R. Shemin, L. Ryan, K. Klegar, R. Osteen, T. Herman, G. Lederman, J. Corson
• Journal: Journal of Clinical Oncology
• Published: 1988;6(1):147-53
• Cited by: 228 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000185).

Abstract

All mesothelioma patients identified by a computer search of pathologic diagnoses at the Dana-Farber Cancer Institute (DFCI) between 1965 and 1985 were the subjects of this analysis. A total of 180 patients were identified, 136 with pleural and 37 with peritoneal mesothelioma. There were five pericardial and two testicular primaries. Of the two decades included in the study, later patients were significantly older, with a more advanced disease stage, and a lower performance status than those accrued early in the study. Factors at diagnosis associated with a significantly prolonged survival for all patients with mesothelioma included a 0 to 1 performance status, absence of chest pain, age less than 50 years, and epithelial histology. Factors at diagnosis associated with prolonged survival for the subset of patients with pleural mesothelioma included epithelial histology, 0 to 1 performance status, the absence of chest pain, an interval of greater than 6 months from onset of symptoms, and treatment with chemotherapy and pleuropneumonectomy. This last result must be interpreted with caution, since this was not a randomized study.

In plain English

This study looked at all 180 patients with a tissue-confirmed diagnosis of malignant mesothelioma seen at the Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston between 1965 and 1985. Of these, 136 had pleural mesothelioma, 37 had peritoneal mesothelioma, and seven had other primary sites (pericardial and testicular). Records for the first 40 patients were reviewed after the fact, and later patients were followed on a registry. About 85% of patients had a recorded exposure history, and 85% of those had asbestos exposure. The article does not name fiber types. Overall median survival was 15 months. Across all patients, longer survival was associated with good performance status, epithelial tissue type, age under 50, and no chest pain at diagnosis. Among pleural patients, longer survival was also associated with more than 6 months from first symptoms to diagnosis, and with chemotherapy plus pleuropneumonectomy. The 19 patients given that treatment had a median survival of 18 months, against 13 months for 117 others. The authors said this treatment result must be interpreted with caution because the study was not randomized.

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 registry analysis: the earliest patients' charts were reviewed retrospectively, and later patients were followed prospectively on a registry. Survival factors were analyzed with Cox proportional hazards regression.
• Who was studied: 180 patients with histologically confirmed malignant mesothelioma seen at the Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, 1965 to 1985: 136 pleural, 37 peritoneal, and 7 other primaries (pericardial and testicular).
• Exposure: Asbestos exposure was recorded as a patient characteristic, not studied as a dose. Smoking and asbestos history were available for about 85% of patients, and 85% of those had asbestos exposure. No fiber types, products or jobs are given.
• Main results:
  • Overall median survival for all 180 patients was 15 months.
  • In the stepwise Cox model for all patients, longer survival at diagnosis was associated with good performance status, epithelial histology, age under 50, and absence of chest pain.
  • All mesotheliomas, by tissue type: epithelial, 110 patients, median survival 17 months; mixed, 41 patients, median 12; sarcomatous, 24 patients, median six.
  • All mesotheliomas, by chest pain: no chest pain, 108 patients, median 17 months; chest pain, 72 patients, median ten.
  • All mesotheliomas, by performance status: status 0, 130 patients, median 16 months; status 1, 27 patients, median ten; status 2 or more, 15 patients, median five.
  • All mesotheliomas, by age at diagnosis: under 50, 49 patients, median 17 months; the older group, 131 patients, median 13.
  • Smoking status and sex appeared related to survival when looked at alone, but the authors report they were no longer significant once other factors were accounted for.
  • Among the 136 pleural patients, an interval of less than 6 months from symptoms to diagnosis was associated with poor survival. Chest pain at diagnosis was also associated with poor survival.
  • Among pleural patients, epithelial histology and good performance status were associated with longer survival.
  • Among pleural patients, pleuropneumonectomy plus chemotherapy was significantly associated with better survival. The 19 treated patients had a median survival of 18 months; the 117 patients labeled 'no treatment' in the figure had a median of 13 months.
  • Pleural patients with more than 6 months from symptoms to diagnosis (35 patients) had a median survival of 17 months; those with 6 months or less (101 patients) had a median of 13 months.
  • Patients seen more recently tended to be older (P = .04), to have higher-stage disease (P < .01), and to have poorer performance status (P < .01) than earlier patients.
• The authors' conclusion: The authors concluded that this larger series confirmed some, but not all, of the prognostic factors found in smaller earlier series. They said the association of chemotherapy plus pleuropneumonectomy with longer survival must be interpreted with caution because the study was not randomized.
• Limitations the authors state:
  • The study was not randomized, so the treatment-survival association must be interpreted with caution.
  • Data were collected over 20 years, partly retrospectively. The authors tested whether period of entry affected survival and found it did not after accounting for other factors.
  • Smoking or asbestos exposure history was missing for 25 patients, all with pleural primaries. The authors judged the missing data to be generally random.
  • The authors note that the effect of chemotherapy on survival is difficult to evaluate, since only patients who respond to it could be expected to benefit.

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: Malignant Mesothelioma, Brigham and Women's Hospital, Mesothelioma, Peritoneal Mesothelioma, Pericardial, Performance Status, Histology, Pleural Mesothelioma.

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