Malignant pleural mesothelioma: single-institution experience of 101 patients over a 15-year period

Our plain-English summary of Malignant pleural mesothelioma: single-institution experience of 101 patients over a 15-year period, by A. Domen, C. De Laet, W. Vanderbruggen, et al (Acta Chirurgica Belgica, 2017).

The study

• Authors: A. Domen, C. De Laet, W. Vanderbruggen, J. Gielis, J.M. Hendriks, P. Lauwers, A. Janssens, B. Hiddinga, J.P. Van Meerbeeck, P.E. Van Schil
• Journal: Acta Chirurgica Belgica
• Published: 2017;117(3):157-163
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive neoplasm that typically originates from the mesothelial surfaces of the pleural cavity. Exposure to asbestos is the principal etiological agent of MPM. The disease is characterized by difficult stage classification and limited consensus on therapeutic approach. We have evaluated the experience with MPM in the Antwerp University Hospital over the past 15 years.

Methods: A database was created with all patients diagnosed with or treated for a MPM between 2001 and 2015. A total of 101 patients were included on which different survival analyses were performed combined with a reproduction of demographic, clinical, histologic and therapeutic data, and these were compared to literature data.

Results: Vast majority of our 101 patients were male (80%) with a median age of 66 years at diagnosis with predominantly epitheloid histology (81%). Overall median survival was 18.3 months and overall 1-, 2- and 5-year survival rates were 68%, 37% and 7%, respectively. Kaplan-Meier analysis showed a non-significant difference in survival between the several best (b) TNM-stages (p = .356). A significant difference in survival was observed in patients undergoing surgery versus no surgery (p = .008), between the different histological types (p < .0001) and treatment with chemotherapy alone versus chemotherapy with surgery (p < .0001). Smoking at diagnosis and epitheloid histology have been identified as significant prognostic factors in the multivariate Cox regression model (HR 3.13 and 0.53, respectively).

Conclusion: Descriptive and survival analysis of our patient database confirmed the limitations of the current staging system and were concordant with literature regarding MPM.

In plain English

This mainly retrospective study reviewed 101 patients with malignant pleural mesothelioma at Antwerp University Hospital, Belgium, 2001 to 2015. Asbestos exposure was documented in 59%, possible in 15%, not reported in the history of 9%, and unknown for 17%. Median survival was 18.3 months (95% CI 14.1 to 22.5); 68%, 37% and 7% survived 1, 2 and 5 years. Survival did not differ significantly by combined clinical/pathologic stage, possibly reflecting underestimated clinical staging, the authors said. Median survival was 19.4 months (95% CI 13.9 to 24.9) for epitheloid, 13.1 (0.0 to 32.8) for biphasic and 5.3 (4.0 to 6.7) for sarcomatoid tumors, a significant difference. The 44 patients with surgery survived longer than the 53 without (median 24.7, CI 16.3 to 33.1, versus 13.6, CI 11.4 to 15.8 months); the authors cautioned this was not corrected for performance status or disease extent. In multivariate analysis, smoking at diagnosis (hazard ratio 3.13) was linked to shorter, and epitheloid type (0.53) to longer, survival; asbestos exposure was not significant. The authors concluded their results largely confirm existing literature, though not always significantly.

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: Single-hospital, mainly retrospective case series (patient database) with survival analyses
• Who was studied: 101 consecutive patients diagnosed with or treated for malignant pleural mesothelioma at Antwerp University Hospital, Belgium, 2001 to 2015; 80% male, median age 66 years at diagnosis
• Exposure: Asbestos exposure history as recorded: documented in 59% of patients, no exposure in their history for 9%, possible in 15%, no data for 17%. No fiber types, products or jobs are reported.
• Main results:
  • All 101 patients: median overall survival 18.3 months (95% CI 14.1 to 22.5)
  • All patients: 1-, 2- and 5-year survival rates of 68%, 37% and 7%
  • Survival by best (combined clinical and pathologic) TNM stage in 99 patients did not differ significantly (p = .356). Median survival was 23.8 months for stage III, 19.4 for stage II, 16.5 for stage IV and 14.9 for stage I. The authors said underestimation of clinical stage may play an important role in this result.
  • Among the 44 patients with pathologic staging, clinical staging was upstaged in 50%, downstaged in 7% and equal in 20%
  • Median survival by tissue type (95% CI): epitheloid 19.4 months (13.9 to 24.9), biphasic 13.1 months (0.0 to 32.8), sarcomatoid 5.3 months (4.0 to 6.7); p less than .0001
  • Excluding 4 vaccination-therapy patients, median survival was 24.7 months (95% CI 16.3 to 33.1) with surgery (n = 44) versus 13.6 months (95% CI 11.4 to 15.8) without surgery (n = 53); p = .008
  • Median survival with chemotherapy plus surgery (n = 18) was 30.6 months versus 14.9 months with chemotherapy alone (n = 24); p less than .0001
  • Median survival after extended pleurectomy/decortication was 26.3 months versus 19.2 months after extrapleural pneumonectomy; the difference was not statistically significant (p = .666)
  • In single-factor (univariate) analysis, epitheloid histology (HR 0.43) and asbestos exposure (HR 0.31) were associated with better survival
  • In the multivariate analysis, smoking at diagnosis (HR 3.13, worse survival) and epitheloid histology (HR 0.53, better survival) remained significant
  • In the multivariate analysis, asbestos exposure was no longer statistically significant (asbestos HR 0.52, p = .427). The same was true for coughing, right-sided tumor, age, chemotherapy and vaccination therapy.
• The authors' conclusion: The authors concluded that their patient population largely confirms current literature on malignant pleural mesothelioma, although their results were not always statistically significant.
• Limitations the authors state:
  • Mainly retrospective design, subject to selection bias
  • Relatively small number of patients (101)
  • Survival analyses could not be corrected for TNM stage
  • Performance score was poorly documented for 2001 to 2008 and was not used to correct the survival analysis
  • The apparent survival advantage with surgery was not corrected for performance status and disease extent
  • Some patients had already received treatment elsewhere before referral
  • Treatment knowledge and guidelines changed over the 15-year period, affecting patient selection, treatment choice and survival

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: Pleural Mesothelioma, Neoplasm, Pleural Cavity, Histology, Median Survival, Chemotherapy, Staging.

Related studies

• Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma — P. Bertoglio, M.C. Ambrogi, et al. (2017)
• Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature — P.A. Moghaddam, K.M. Cornejo, et al. (2013)
• Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience — J. Wong, A.L. Koch, et al. (2014)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• Well-differentiated papillary mesothelioma: A 17-year single institution experience with a series of 75 cases — M. Sun, L. Zhao, et al. (2019)
• Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania — C. Spatola, C. Militello, et al. (2018)

Browse more research in Acta Chirurgica Belgica, or return to medical research.