Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases

Our plain-English summary of Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases, by Z.T. Selçuk, L. Cöplü, S. Emri, et al (Chest, 1992).

The study

• Authors: Z.T. Selçuk, L. Cöplü, S. Emri, A.F. Kalyoncu, A.A. Sahin, Y.I. Bariş
• Journal: Chest
• Published: 1992;102(3):790-6
• Cited by: 77 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. 004924).

Abstract

We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.

In plain English

This study reviewed records of 135 people with malignant pleural mesothelioma (cancer of the lining around the lungs) seen at Hacettepe University Hospital in Ankara, Turkey, between 1981 and 1990. None had worked with asbestos or erionite. Their exposure came from where they lived in Central Anatolia. Fifty-eight came from three villages with erionite, a natural mineral fiber found in volcanic rock. Seventy-seven came from over 30 villages using asbestos-contaminated soil, for example as whitewash. The most common symptoms were shortness of breath (80 percent) and nonpleuritic chest pain (71 percent). Median survival after diagnosis was 13.52 months in the erionite group and 21.56 months in the asbestos group, a statistically significant difference. However, 39 asbestos-group patients were lost to follow-up. The authors warned this may have made asbestos-group survival look longer, so the difference should be viewed cautiously. Treatment status showed no significant link to survival. The authors concluded that the strongest diagnostic clues were the patient's village and the typical presentation: fluid around one lung (unilateral exudative pleural effusion) with nonpleuritic chest pain.

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 patient records (case series)
• Who was studied: 135 patients with malignant pleural mesothelioma seen at Hacettepe University Hospital, Ankara, Turkey, between January 1981 and December 1990. 58 were from three erionite villages (Tuzkoy, Karain, Sarihidir) and 77 were from more than 30 asbestos villages in Central Anatolia. Of 183 patients found in the records, 48 were excluded for incomplete data.
• Exposure: Environmental (non-occupational) exposure to either erionite, a natural fibrous zeolite in volcanic rock, or asbestos. The authors state that the asbestos in most of the region is tremolite or chrysotile. Villagers used asbestos-contaminated 'white soil' as whitewash or plaster and for other household purposes. The authors state there was no occupational exposure.
• Main results:
  • Median survival after diagnosis was 13.52 plus or minus 0.73 months in the erionite-exposed group and 21.56 plus or minus 0.77 months in the asbestos-exposed group.
  • The authors reported the survival difference between the erionite and asbestos groups as statistically significant.
  • Median survival from the onset of symptoms was 16.80 months in the erionite-exposed group and 36.16 months in the asbestos-exposed group.
  • Survival after diagnosis at 12 and 24 months was 64 and 15 percent in the erionite-exposed group, and 79 and 42 percent in the asbestos-exposed group.
  • 39 of 135 patients (29 percent), all from the asbestos-exposed group, could not be followed up.
  • In the erionite-exposed group, treatment status and stage at presentation had no impact on survival. In the asbestos-exposed group, of sex, treatment status and stage, only sex was significantly related to survival.
  • The most common symptoms at presentation across all 135 patients were dyspnea (shortness of breath, 80 percent) and nonpleuritic chest pain (71 percent).
  • Mean age was 46.4 years in the erionite-exposed group and 49.7 years in the asbestos-exposed group.
  • The tissue diagnosis was made by pleural biopsy in 53 of 135 patients (39 percent) and by thoracoscopy in 52 (39 percent).
  • Tumor grew in the tract of the thoracotomy incision or pleural biopsy site in 13 patients (10 percent).
• The authors' conclusion: The authors concluded that the strongest factors suggesting the diagnosis were the patient's village of residence and the typical presentation: a unilateral (one-sided) exudative pleural effusion with nonpleuritic chest pain.
• Limitations the authors state:
  • Because many asbestos-group patients were lost to follow-up, median survival in that group may have been biased toward a longer duration, and the survival difference should be regarded with caution.
  • The greater number of men than women in the asbestos group may be partly explained by referral bias.
  • 12 patients, all from the erionite group, could not be staged because of inadequate clinical and radiologic information.
  • Treatment regimens varied greatly and were often combined, so they were not reported separately.

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, Mineral Fiber, Pleural Effusion, Thoracoscopy, Pleural Biopsy, Median Survival, erionite.

Related studies

• Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients — A.A. Sahin, L. Cöplü, et al. (1993)
• Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study — M. Artvinli, Y.I. Baris (1982)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Significance of mass and number of fibers in the correlation of V79 cytotoxicity with tumorigenic potential of mineral fibers — L.D. Palekar, B.M. Most, et al. (1988)
• Genetic predisposition to fiber carcinogenesis causes a mesothelioma epidemic in Turkey — A.U. Dogan, Y.I. Baris, et al. (2006)
• Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey — A. Senyiğit, C. Babayiğit, et al. (2000)

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