Natural history and staging of malignant mesothelioma

Our plain-English summary of Natural history and staging of malignant mesothelioma, by K.H. Antman (Chest, 1989).

The study

• Author: K.H. Antman
• Journal: Chest
• Published: 1989;96(1 Suppl):93S-95S
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This conference paper reviewed the clinical course and staging of malignant mesothelioma, drawing on published series including a registry of 180 patients. Patients with pleural mesothelioma were typically aged 50 to 80 years (median 60) and first sought care for shortness of breath, chest wall pain, or both. Men outnumbered women 2-5 to 1, which the author presumed reflected workplace exposure. Most patients had a large one-sided pleural effusion. About 60% had right-sided tumours and fewer than 5% had disease on both sides. Pleural plaques or lung fibrosis appeared on chest x-rays in only about 20% of patients, despite a history of asbestos contact in 50-70%. Calcifications were seen on CT in almost half and at autopsy in up to 87%. Painful masses at earlier procedure sites developed in about 10%. Clotting abnormalities were seen in up to 20% of patients with peritoneal mesothelioma. Median survival was 6-18 months across series, ranging from weeks to 16 years, and death was usually from respiratory failure. Longer survival was associated with younger age, good performance status, epithelial histology, no chest pain at diagnosis, and treatment with pleuropneumonectomy and chemotherapy. Four published staging systems were compared. The author concluded that none reproducibly predicted survival, that CT was indicated if treatment was contemplated, and that extensive baseline testing for metastases was usually nonproductive.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This short article was an overview of how malignant mesothelioma, mainly pleural mesothelioma, typically appears and progresses, and of systems for staging it. It drew on published patient series, including the author's own, and described no new study methods. Patients were described as typically aged 50 to 80 years (median 60), with a male-to-female ratio printed as "2-5:1", which the author presumed reflected workplace exposure. About 60% had right-sided disease and fewer than 5% had both sides involved. Pleural plaques or interstitial fibrosis showed on chest x-ray in only about 20% of patients, although 50-70% had a history of asbestos contact. Median survival in various series was 6-18 months, ranging from weeks to 16 years. Younger age, a performance status of 0-1, epithelial tumor type, no chest pain at diagnosis, and treatment with pleuropneumonectomy and chemotherapy were associated with significantly longer survival. The author reported that no published staging system reproducibly predicted survival with statistical significance. The author also judged extensive baseline testing for spread nonproductive when patients had no symptoms or laboratory abnormalities.

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: Narrative review (clinical overview) summarizing published patient series, including the author's own; no new study methods are described
• Who was studied: Patients with malignant mesothelioma, mainly pleural, as described in published series. Survival tables draw on a Dana-Farber registry of 180 patients and a Mt. Sinai series of 69 patients.
• Exposure: Not studied directly. The article notes a history of asbestos contact in 50-70% of patients with pleural mesothelioma, and that the excess of men presumably reflects workplace exposure. No fiber types are named.
• Main results:
  • The ratio of men to women among patients was printed as 2-5:1
  • Approximately 60% of patients presented with right-sided primary lesions and fewer than 5% with bilateral involvement
  • Pleural plaques or interstitial fibrosis were visible on chest x-ray in only about 20% of patients with pleural mesothelioma, despite a history of asbestos contact in 50-70%. Calcifications were documented on CT in almost half and at autopsy in up to 87%.
  • Painful masses, generally at sites of prior thoracocentesis, chest tube drainage or thoracotomy, developed in about 10% of patients
  • Clotting abnormalities were observed in up to 20% of patients with peritoneal mesothelioma
  • Patients generally died of respiratory failure after a median survival of 6-18 months in various series (range: weeks to 16 years)
  • Inanition and small bowel obstruction from direct extension through the diaphragm developed in about one third of patients
  • Younger age, 0-1 performance status, epithelial histology, lack of chest pain at diagnosis, and therapy with pleuropneumonectomy and chemotherapy were associated with significantly longer survival
  • None of the published staging systems reproducibly predicted survival with statistical significance
  • Bone, brain and liver metastases, or extension into other serosal surfaces, were found at autopsy in more than half of patients
  • A markedly elevated serum CEA suggests a diagnosis other than mesothelioma
• The authors' conclusion: The author concluded that, without symptoms or laboratory abnormalities, clinically relevant metastases are uncommon enough at presentation that extensive baseline evaluation is nonproductive

Topics

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

Medical terms in this study, explained in our Lexicon: Staging, Malignant Mesothelioma, Pleural Mesothelioma, Pleural Effusion, Pleural Plaques, Fibrosis, Chest X-Ray, Autopsy.

Related studies

• Epidemiology, biologic behavior, and natural history of mesothelioma — L. Zellos, D.C. Christiani (2004)
• Multimodality therapy for malignant mesothelioma based on a study of natural history — K.H. Antman, R.H. Blum, et al. (1980)
• Natural history and epidemiology of malignant mesothelioma — K.H. Antman (1993)
• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)
• The natural history of asbestosis in former crocidolite workers of Wittenoom Gorge — W. Cookson, N. De Klerk, et al. (1986)
• Natural history of pleural thickening after exposure to crocidolite — N.H. de Klerk, W.O. Cookson, et al. (1989)

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