Malignant pleural mesothelioma: A retrospective analysis of clinicopathological and survival data

Our plain-English summary of Malignant pleural mesothelioma: A retrospective analysis of clinicopathological and survival data, by A.M. Adel, Z.M. Abdel Hafeez, E.T. El Sheikh, et al (Thoracic Cancer, 2011).

The study

• Authors: A.M. Adel, Z.M. Abdel Hafeez, E.T. El Sheikh, I.A. El Sharawy, N.S. Gobran
• Journal: Thoracic Cancer
• Published: 2011;2(1):16-23
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The aim of this study was to analyze the clinicopathological features of malignant pleural mesothelioma (MPM) and evaluate the therapeutic measures offered to patients with MPM and their impact on survival.

Methods: Data was retrospectively collected from the medical records of 304 patients who presented to the Department of Clinical Oncology and Nuclear Medicine, Ain Shams University between January 2003 and December 2008.

Results: The mean age of patients was 52.1 years (range 24-87 years). One hundred and ninety patients (62.5%) came from endemic areas and/or gave history of occupational asbestos exposure. One hundred and sixty-nine patients received chemotherapy. There was a significant difference between the median survival for patients who received chemotherapy (9 months, 95% CI 7.69-10.30) and those who were offered best supportive care (2 months, 95% CI 0.09-3.91). Other factors that affected the survival negatively were: non-epithelial pathology (P= 0.001); age >50 years (P= 0.012); bad performance status (P= 0.001); non-platinum based chemotherapy (P= 0.0001); and progressive disease (P= 0.000). Cox regression analysis revealed that the factors that predicted shorter survival were patients being offered best supportive care rather than chemotherapy and progressive disease.

Conclusion: MPM is a growing health problem in Egypt that needs more attention. The current analysis of data reflects the importance of maintaining a high index of suspicion to allow for early diagnosis, especially for cases that live in areas with high asbestos exposure and for people who work in occupations that expose them to asbestos as well as their family members. Prospective randomized trials comparing multimodality approaches to other forms of treatment and including quality of life assessment are warranted.

© Tianjin Lung Cancer Institute and Blackwell Publishing Asia Pty. Ltd.

In plain English

This study reviewed the records of 304 patients with malignant pleural mesothelioma (a cancer of the lining around the lungs) referred to the oncology department at Ain Shams University Hospitals, Cairo, Egypt, from January 2003 to December 2008. Mean age was 52.1 years; half were women. 190 (62.5%) came from areas the authors call endemic (Shoubra El Kheima, Helwan, El Hawamdia) and/or had a history of occupational asbestos exposure. The study does not say which asbestos fiber types they were exposed to. Almost all women came from endemic areas. For the 181 patients with survival data, median survival was 8.00 months (95% CI 6.69–9.30). Median survival was 9.00 months (95% CI 7.69–10.30) with chemotherapy and 2.00 months (95% CI 0.09–3.91) with best supportive care only. The authors noted that supportive care went to older, sicker patients. In combined analysis, best supportive care and disease progressing despite chemotherapy were each independently linked to shorter survival. The authors concluded that mesothelioma is a growing problem in Egypt and should be suspected early in people from high-exposure areas, asbestos workers and their families.

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 review of hospital medical records (single-department case series with survival analysis)
• Who was studied: 304 patients with pathologically confirmed malignant pleural mesothelioma referred to the Clinical Oncology department, Ain Shams University Hospitals, Cairo, Egypt, January 2003 to December 2008. The group was 152 men and 152 women, mean age 52.1 years. Survival data were available for 181 patients.
• Exposure: Asbestos exposure was recorded from patient histories. 190 patients (62.5%) came from endemic areas and/or had a history of occupational asbestos exposure, 90 (29.6%) were negative and 24 (7.9%) unknown. Most came from Shoubra El Kheima (101 patients). The study does not identify the fiber types or doses to which its own patients were exposed. The main focus was treatment (chemotherapy, palliative radiotherapy, pleural tapping, best supportive care) and survival.
• Main results:
  • Almost all female patients came from endemic areas. The male to female ratio was 1:1.
  • Median overall survival for the 181 patients with survival data was 8.00 months (95% CI 6.69–9.30).
  • Patients who received chemotherapy had a median survival of 9.00 months (95% CI 7.69–10.30). Patients given best supportive care had a median survival of 2.00 months (95% CI 0.09–3.91). The text gives P = 0.001.
  • Median survival was 9 months for patients on cisplatin-based chemotherapy, 5 months for non-cisplatin-based chemotherapy, and 2 months for best supportive care. Among chemotherapy patients, median survival was 15 months for responders and 6 months for those whose disease progressed.
  • Of 152 chemotherapy patients assessable for response, 4 (2.6%) had complete response, 33 (21.7%) partial response, 68 (44.7%) stable disease and 47 (30.9%) progressed. For analysis, 'responders' included complete response, partial response and stable disease (105 patients), and 'non-responders' were those with progressive disease (47 patients).
  • In single-factor (univariate) analysis, several factors were linked to shorter survival according to the text: non-epithelial pathology (P = 0.001), age over 50 years (P = 0.012), bad performance status (P = 0.001), non-platinum chemotherapy (P = 0.0001) and progressive disease (P = 0.000). Sex had no prognostic significance.
  • In Cox regression, best supportive care and non-response to chemotherapy (meaning progressive disease) were independently associated with decreased survival.
  • In Table 3, non-responders (progressive disease) had a hazard ratio of 5.528 (95% CI 3.278 to 9.323, P = 0.0001). Best supportive care had a hazard ratio of 4.945 (95% CI 2.038 to 11.999, P = 0.0001).
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma is a growing health problem in Egypt needing more attention. They said a high index of suspicion is needed for early diagnosis, especially for people living in high asbestos exposure areas, workers in asbestos-exposed occupations, and their family members. They called for prospective randomized trials of multimodality treatment that include quality of life assessment.
• Limitations the authors state:
  • The study was retrospective, which the authors called a major limitation.
  • In 69% of patients, pathology was based on cytology or small CT-guided biopsies without immunohistochemistry, so diagnoses may be inaccurate.
  • There were small numbers of mixed (35) and sarcomatoid (21) cases compared with epithelial cases (202), which may introduce error into the statistics.
  • Staging was not included in the analysis because retrospective TNM staging was judged inaccurate.
  • Best supportive care was given to elderly patients and those with bad performance status or significant comorbidities. The authors said this could explain the lower survival in that group.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Endemic, Asbestos Exposure, Chemotherapy, Median Survival, Pathology, Performance Status, Quality of Life.

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