Malignant pleural mesothelioma: a clinicopathological study

Our plain-English summary of Malignant pleural mesothelioma: a clinicopathological study, by J.C. Qua, U.N. Rao, H. Takita (Journal of Surgical Oncology, 1993).

The study

• Authors: J.C. Qua, U.N. Rao, H. Takita
• Journal: Journal of Surgical Oncology
• Published: 1993;54(1):47-50
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In this paper the results of a retrospective review of 58 patients with malignant pleural mesothelioma treated at our Institute are reported. There were 50 males and 8 females; the mean age was 56.3 years (range: 13-77). History of asbestos exposure was ascertained in 25 patients (43%). The most common finding in chest X-ray was pleural effusion which was seen in 47/58 patients on presentation. The cytological examination of pleural effusion was most of the time nondiagnostic. Pleural biopsy was needed for the correct diagnosis. Pathologically, 26 patients (44.8%) had epithelial type, 24 patients (41.4%) had mixed type, and 8 patients (13.8%) had fibrous or sarcomatous type of pleural mesothelioma. Most of the patients on presentation had Stage I disease by Butchart's classification. The overall survival time ranged from 1 month to as long as 17 years with a median of 12.5 months. The mean survival of patients who received nonsurgical therapies was 7-13.4 months. Thirteen patients were treated surgically: three patients survived over 5 years, but the median survival was 15 months. Six patients received no treatment, and the median survival was seven months.

In plain English

The authors reviewed 58 patients with histologically confirmed malignant pleural mesothelioma treated at Roswell Park Cancer Institute, Buffalo, New York, between January 1966 and December 1990 (50 men, 8 women; mean age 56.3 years). A history of asbestos exposure was obtained for 25 patients (43.1%), questionable exposure for 19 and no exposure for 14. Fiber types were not reported. Only five patients showed asbestos fibers or ferruginous bodies. Pleural effusion appeared on chest X-ray in 47 of 58 patients. Of 17 patients whose fluid showed malignant cells, only four were correctly identified as having mesothelioma by cytology. Tumors were epithelial in 26 patients, mixed in 24 and fibrous in 8. Median overall survival was 12.5 months. Median survival was 15 months for 13 surgically treated patients, 10 months for 25 who received chemotherapy, and seven months for six untreated patients. Four patients survived over five years, but all died of recurrent disease. The authors concluded that the logical approach would be surgery to remove gross disease, followed by effective nonsurgical 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: Retrospective clinicopathological review of patients treated at a single institute
• Who was studied: 58 patients with histologically confirmed malignant pleural mesothelioma at Roswell Park Cancer Institute, Buffalo, New York, January 1966 to December 1990. There were 50 males (86.2%) and 8 females (13.8%), with a mean age of 56.3 years (range 13 to 77). All but one patient had died by the time of the review.
• Exposure: Asbestos exposure history: obtained in 25 patients (43.1%), questionable in 19 (32.8%), negative in 14 (24.1%). No fiber types, products, jobs or doses were reported.
• Main results:
  • Pleural effusion was seen on chest X-ray in 47 of the 58 patients at presentation (unilateral in 44, bilateral in 3).
  • Thoracentesis was done in 46 patients, and 17 had malignancy on cytology. In only four of these was mesothelioma correctly diagnosed by cytology. In seven, the malignant cells were wrongly interpreted as lung carcinoma.
  • Histology: epithelial type in 26 patients (44.8%), mixed or biphasic type in 24 (41.4%), fibrous type in 8 (13.8%).
  • Only five patients showed asbestos fibers or ferruginous bodies (spelled 'ferroginous' in the article).
  • By Butchart staging, most patients were in Stage I at diagnosis. Three were in Stage II, one in Stage III and none in Stage IV.
  • Of 23 patients autopsied, 16 (70%) had distant metastasis and 7 (30%) had only local extension.
  • Overall survival in all 58 patients ranged from 1 month to 17 years and 9 months, with a median of 12.5 months.
  • Six patients treated with radiotherapy alone had a mean survival of 7 months.
  • 25 patients who received chemotherapy had a mean survival of 13.4 months and a median of 10 months.
  • Seven patients treated with chemotherapy plus radiotherapy had a mean survival of 8.1 months and a median of 6 months.
  • 13 surgically treated patients had a mean survival of 41.2 months and a median of 15 months.
  • Six untreated patients had a mean survival of 6.1 months and a median of seven months.
  • Four of the 58 patients survived more than 5 years, but all eventually died of recurrent disease.
• The authors' conclusion: The authors concluded that the logical treatment approach would be first to remove gross primary disease by surgery and then follow with effective nonsurgical treatment. In their view, chemotherapy and/or radiation alone probably would not be effective.

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, Asbestos Exposure, Chest X-Ray, Pleural Effusion, Pleural Biopsy, Overall Survival, Median Survival.

Related studies

• Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data — J.B. Grogg, J.N. Fronzaroli, et al. (2021)
• Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India — P.A.M. Paul, N. Calton, et al. (2021)
• Prognostic factors affecting survival in malignant pleural mesothelioma: analysis of 125 subjects — B. Komurcuoglu, A.K. Cirak, et al. (2014)
• Trimodality Treatment of Malignant Pleural Mesothelioma: An Institutional Review — M. Kapeles, M.F. Gensheimer, et al. (2018)
• Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases — V.L. Roggli, A. Sharma, et al. (2002)
• Well-differentiated papillary mesothelioma: a clinicopathological and immunohistochemical study of 18 cases with additional observation — X. Chen, W. Sheng, et al. (2013)

Browse more research in Journal of Surgical Oncology, or return to medical research.