Management of malignant pleural mesothelioma - part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database

Our plain-English summary of Management of malignant pleural mesothelioma - part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database, by T. Klikovits, M.A. Hoda, Y. Dong, et al (Wiener Klinische Wochenschrift, 2016).

The study

• Authors: T. Klikovits, M.A. Hoda, Y. Dong, M. Arns, B. Baumgartner, P. Errhalt, C. Geltner, B. Machan, W. Pohl, J. Hutter, J. Eckmayr, M. Studnicka, M. Flicker, P. Cerkl, K. Kirchbacher, W. Klepetko
• Journal: Wiener Klinische Wochenschrift
• Published: 2016;128(17-18):627-34
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor originating from the pleural cavity with a strong link to previous asbestos exposure. In order to determine the demographics, diagnostics, therapeutic strategies, and prognosis of MPM patients in Austria, the Austrian Mesothelioma Interest Group (AMIG) was founded in 2011. In this report the data from the AMIG MPM database collected to date are reported.

Methods: A prospective observational registry was initiated, including patients with histologically verified MPM diagnosed and treated at specialized centers in Austria. Patient inclusion started in January 2011 and follow-up was completed until September 2015.

Results: A total number of 210 patients were included. There were 167 male and 43 female patients with a mean age of 67.0 years (SD ± 11.3) at the time of diagnosis. Asbestos exposure was confirmed in 109 (69.4 %) patients. The histological subtype was epithelioid in 141 (67.2 %), sarcomatoid in 16 (7.6 %), biphasic in 28 (13.3 %), and MPM not otherwise specified in 25 (11.9 %) patients. Of the patients, 30 (14.3 %) received best supportive care (BSC) only, 71 (33.8 %) chemotherapy (CHT) alone, four (1.9 %) radiotherapy (RT) alone, 23 (11.9 %) CHT/RT, two (0.9 %) surgery alone, and 76 (36.2 %) curative surgery within a multimodality treatment (MMT), which was more frequently performed for patients younger than 65 years and with early-stage disease (I + II). Median overall survival (OS) was 19.1 months (95 % CI 14.7-23.5). The 1‑, 3‑, and 5‑year OS rates were 66 %, 30 %, and 23 %, respectively, and OS was significantly better in patients undergoing surgery within MMT (5-year survival 5 % vs. 40 %, p = 0.001).

Conclusion: Patients with earlier disease stages, younger age, good performance status, and epithelioid histology were more likely to undergo MMT including surgery, which resulted in a more favorable outcome.

In plain English

This study reported the first data from Austria's nationwide prospective registry of malignant pleural mesothelioma (MPM), run by the Austrian Mesothelioma Interest Group at 25 centers. It included 210 patients whose MPM was confirmed by tissue examination between January 2011 and July 2015, followed until September 2015. Of 157 patients with exposure information, 109 (69.4 %) had confirmed asbestos exposure. The authors wrote that almost all of this exposure was occupational. No fiber types were reported. Most tumors (141 patients) were epithelioid. In 185 patients with enough data for survival analysis, median overall survival was 19.1 months (95 % CI 14.7 to 23.5) and estimated 5-year survival was 23 %. Estimated 5-year survival was 40 % for the 76 patients who had surgery within combined treatment, versus 5 % for other patients. However, these patients were younger, had earlier-stage disease, were in better general condition and more often had epithelioid tumors. When these factors were analyzed together, only general condition (Karnofsky index) and tumor subtype remained statistically significant. The authors concluded that patients with favorable features were more likely to receive combined treatment including surgery, which resulted in a more favorable outcome.

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: Prospective multi-center observational tumor registry (national mesothelioma database)
• Who was studied: 210 patients with histologically verified malignant pleural mesothelioma at 25 centers in Austria: 167 male and 43 female, mean age 67.0 years. MPM was verified between January 2011 and July 2015, and follow-up ran until September 2015.
• Exposure: Asbestos exposure was confirmed in 109 patients (69.4 %; Table 1 gives 157 patients with exposure information). The authors state it was almost always occupation-related. No fiber types, products or doses are reported.
• Main results:
  • Survival analysis was possible for 185 of 210 patients (88.1 %). Median overall survival was 19.1 months (95 % CI 14.7 to 23.5). Estimated overall survival (Kaplan–Meier) was 66 % at 1 year, 30 % at 3 years and 23 % at 5 years.
  • Patients with early-stage disease (stages I and II) had longer median survival than those with late-stage disease (stages III and IV): 26.4 vs 13.0 months, HR 0.55, 95 % CI 0.35 to 0.86, p = 0.002.
  • Patients with epithelioid tumors had longer median survival than those with non-epithelioid tumors: 25.1 vs 10.2 months, p = 0.003.
  • Estimated 5-year survival was 40 % in patients who had surgery within multimodality treatment, compared with 5 % in patients given other treatments (p = 0.001).
  • Patients receiving multimodality treatment were significantly younger and differed from other patients in stage, performance status and histology.
  • In the multivariate Cox regression, only performance status (HR 0.96, 95 % CI 0.94 to 0.96, p = 0.001) and histological subtype (non-epithelioid vs epithelioid, HR 1.8, 95 % CI 1.06 to 3.07, p = 0.031) remained significant. Treatment (other vs multimodality, HR 1.72, p = 0.075 in Table 3) did not.
  • No survival difference was found between males and females, or between patients below and above age 65.
  • In patients having curative-intent surgery, the postoperative complication rate was 21.8 % (17 patients), and no patients died within 30 days.
  • By the end of follow-up, 99 patients (47.1 %) had died. The cause of death was tumor related in 85 of them (85.9 %).
• The authors' conclusion: The authors concluded that patients with earlier disease stages, younger age, good performance status and epithelioid histology were more likely to undergo multimodality treatment including surgery, which resulted in a more favorable outcome.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Pleural Cavity, Asbestos Exposure, Prognosis, Histological Subtype, Epithelioid, Sarcomatoid.

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