Multi-institutional survey of malignant pleural mesothelioma patients in the Hokushin region

Our plain-English summary of Multi-institutional survey of malignant pleural mesothelioma patients in the Hokushin region, by H. Uramoto, T. Takiguchi, T. Koizumi, et al (Journal of Cancer Research and Clinical Oncology, 2022).

The study

• Authors: H. Uramoto, T. Takiguchi, T. Koizumi, A. Tanimoto, R. Hayashi, Y. Nakazawa, K.I. Ito, M. Nakada, Y. Hirono, Y. Nishino, S. Yano
• Journal: Journal of Cancer Research and Clinical Oncology
• Published: 2022;148(5):1153-1158
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a major occupational and environmental neoplasm. The purpose of this study was to validate the clinical and epidemiological factors, diagnosis, and initial treatment among MPM patients in the Hokushin region.

Methods: We surveyed retrospective data from 152,921 cancer patients in 22 principal hospitals.

Results: A total of 166 MPM cases were newly diagnosed. These patients consisted of 136 men and 30 women, with a median age of 69 years. We estimated the incidence rate for MPM to be 0.55 cases per 100,000 person-years in this study. The ratio per 100,000 population-years was 0.39 in Fukui, 0.60 in Ishikawa, 1.02 in Toyama and 0.35 in Nagano. Forty-five patients were discovered when diagnosed incidentally in patients under observations for other diseases. Forty-six cases were diagnosed as localized disease, while 13 had accompanying regional lymph node metastasis. Furthermore, 44 cases showed infiltration into adjacent organs. A histo-cytological diagnosis was made in 164 cases (98.8%). A surgical approach, chemotherapy, and radiotherapy were performed for 33, 88, and 6 patients, respectively, while 44 patients (26.5%) received best supportive care. Multimodality therapy was conducted in just 3.0% of the MPM patients CONCLUSION: MPM has a tragically rapid progression if discovered under observations for other diseases. Workers in health-related fields should be on high alert for aggressive MPM. Better evaluation and multi-disciplinary approaches to MPM in these regions are needed to optimize multimodality therapy.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

In plain English

This study reviewed hospital cancer registry records from 22 principal hospitals in Japan's Hokushin region (Ishikawa, Toyama, Fukui and Nagano Prefectures). The records covered 2010 to 2015 and listed 152,921 cancer patients. Of these, 166 people were newly diagnosed with malignant pleural mesothelioma: 136 men and 30 women, with a median age of 69. The authors estimated an overall incidence of 0.55 cases per 100,000 person-years. By prefecture it ranged from 0.35 in Nagano to 1.02 in Toyama. Forty-five cases were found while patients were being followed for other diseases. At diagnosis, 46 cases were localized and 47 had distant metastasis. Pathology confirmed 98.8% of diagnoses. Thirty-three patients had surgery, 88 chemotherapy and 6 radiotherapy. Forty-four (26.5%) received best supportive care only, and this group was older on average. Only 3.0% (5 of 166) received multimodality therapy. The article gives no data on patients' asbestos exposure. The authors called for better evaluation and multidisciplinary care in the region. They noted that the registry lacked survival and treatment-effect data.

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 multi-institutional survey of hospital-based cancer registry data (the Hokushin Ganpro database)
• Who was studied: 152,921 cancer patients registered at 22 principal hospitals in the Hokushin region of Japan (Ishikawa, Toyama, Fukui and Nagano Prefectures), January 1, 2010 to December 31, 2015; 166 newly diagnosed malignant pleural mesothelioma cases were analyzed
• Exposure: Asbestos exposure was not measured. The authors could not obtain data on asbestos use by prefecture, and fiber types in patients' pleura could not be analyzed.
• Main results:
  • Of the 166 malignant pleural mesothelioma patients, 136 (82%) were men and 30 (18%) were women; median age was 69 years (range 45 to 92)
  • Estimated overall incidence was 0.55 cases per 100,000 person-years
  • Rate per 100,000 population-years by prefecture: 0.39 in Fukui, 0.60 in Ishikawa, 1.02 in Toyama and 0.35 in Nagano
  • Annual case counts: 26 in 2010, 23 in 2011, 34 in 2012, 22 in 2013, 32 in 2014 and 26 in 2015
  • Route of discovery: 45 cases were found under observation for other diseases and 92 were referred from another hospital (9 others via cancer screening, 9 via health checkups, 11 voluntary)
  • Disease extent: 46 localized, 13 with regional lymph node metastasis, 44 with infiltration into adjacent organs, 47 with distant metastasis, 16 unknown
  • 164 cases (98.8%) had a histological or cytological diagnosis; histological subtypes were epithelioid 48 (28.9%), sarcomatoid 24, biphasic 19, not otherwise specified 75 (45.2%)
  • Treatment: surgery in 33 patients, chemotherapy in 88 and radiotherapy in 6; 44 patients (26.5%) received best supportive care
  • Multimodality therapy was given to 3.0% of patients (5 of 166)
  • Patients receiving best supportive care were significantly older (mean 77.5 years) than treated patients (mean 67.4 years), p less than 0.0001; the two groups did not differ significantly in extent of disease
• The authors' conclusion: The authors concluded that MPM progresses rapidly when discovered during observation for other diseases, that health-related workers should be on high alert for aggressive MPM, and that better evaluation and multidisciplinary approaches are needed in these regions to optimize multimodality therapy.
• Limitations the authors state:
  • The study was retrospective and based on cancer registration data from domestic institutions
  • Survival information, treatment sequence and therapeutic effect were unclear
  • The type of asbestos fibers in patients' pleura could not be analyzed because surgery or autopsies were not performed in these cases
  • Adequate data on differences in asbestos use by prefecture could not be obtained

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, Incidence, Metastasis, Chemotherapy, Multimodal Therapy.

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