Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis

Our plain-English summary of Outcome and prognostic factors of pleural mesothelioma after surgical diagnosis and/or pleurodesis, by M. Baud, S. Strano, A. Dechartres, et al (The Journal of Thoracic and Cardiovascular Surgery, 2013).

The study

• Authors: M. Baud, S. Strano, A. Dechartres, R. Jouni, F. Triponez, C. Chouaid, P. Forgez, D. Damotte, N. Roche, J.F. Régnard, M. Alifano
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2013;145(5):1305-11
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma.

Methods: All consecutive patients referred for surgical diagnosis and/or pleurodesis for malignant pleural mesothelioma between 2000 and 2010 were studied. The following parameters were prospectively recorded: age, sex, tobacco consumption, asbestos exposure, type and duration of symptoms, American Society of Anesthesiologists (ASA) score, body mass index, preoperative C-reactive protein levels, white blood cells and platelet count, pachypleuritis on chest radiograph, type of diagnostic surgical procedure, histologic type, modality of pleurodesis, and chemotherapy. Survival was assessed on March 1, 2011.

Results: A total of 170 patients were included. For the entire population, median survival was 12 months (95% confidence interval [CI], 10-15). Two-, 5-, and 7-year overall survival was 26% (95% CI, 19-35), 11% (95% CI, 6-21), and 5% (95% CI, 9-22), respectively. Asbestos exposure, age, ASA class III versus ASA classes I and II, nonepithelioid histology, C-reactive protein levels >3 mg/L, and white cell count >12,000/mm(3) influenced outcome in univariate analysis. Multivariate analysis showed that nonepithelioid histology (hazard ratio [HR], 2.76; 95% CI, 1.50-5.08); age (HR, 1.05; 95% CI, 1.01-1.08); C-reactive protein levels between 4 and 50 mg/L, and >51 (HR, 2.28; 95% CI, 1.18-4.42; and HR, 2.69; CI, 1.29-5.60, respectively); and leukocytosis >12,000/mm(3) (HR, 2.28; 95% CI, 1.22-4.25) were independent worse survival predictors.

Conclusions: Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival.

Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

In plain English

This study followed 170 consecutive patients with malignant pleural mesothelioma who had diagnostic surgery and/or pleurodesis, not curative surgery, at a Paris hospital from 2000 to 2010. Data were collected prospectively and reviewed retrospectively. Survival on March 1, 2011, was known for 159 patients. Identified asbestos exposure was recorded in 73 patients (the table gives 46%, without stating its denominator). Median survival was 12 months (95% CI 10 to 15); estimated survival was 26% at 2 years (95% CI 19 to 35) and 11% at 5 years (95% CI 6 to 21). In single-factor analyses, asbestos exposure, age, male sex, higher anesthesia risk class, non-epithelioid tumor type, raised C-reactive protein (CRP) and a high white cell count were linked to shorter survival. In the combined analysis, non-epithelioid tumor type, older age, raised CRP and a white count above 12,000 per mm3 remained independent predictors of worse survival. Asbestos exposure was not among them. The authors concluded that survival remains poor and that systemic inflammation seems to predict poor outcome. They named the retrospective design and varied chemotherapy as limitations.

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-center cohort study of consecutive patients. Data were collected prospectively and reviewed retrospectively. Survival was analyzed with Kaplan-Meier curves and with univariate and multivariate Cox models.
• Who was studied: 170 patients with malignant pleural mesothelioma (MPM) referred to the thoracic surgery department of Hôtel-Dieu Hospital, Paris, France, from November 1, 2000 to October 31, 2010, for video-assisted or open pleural biopsy and/or pleurodesis. Of 202 surgical procedures, 32 had curative intent and were excluded. Of the 170 patients, 121 (71%) were men, and the mean age was 72.7 years.
• Exposure: The study examined factors that predict survival, not asbestos exposure as such. Identified asbestos exposure was recorded as yes or no. Table 1 reports it for 73 patients, given as 46%; the denominator is not stated, and 73 is about 43% of all 170 patients. No fiber types, jobs or doses were reported. Other factors studied included age, sex, smoking, anesthesia risk class, CRP, white cell and platelet counts, histologic type and type of surgery.
• Main results:
  • Whole study population: median survival was 12 months (95% CI, 10-15).
  • Whole study population: overall survival was 26% (95% CI, 19-35) at 2 years and 11% (95% CI, 6-21) at 5 years. Survival at 7 years was printed as 5%, but its printed confidence interval (9-22) is inconsistent with that figure.
  • Follow-up: survival information was available for 159 patients (94%). At study completion, 40 were alive and 119 were dead.
  • Univariate analysis: patients with identified asbestos exposure had a crude hazard ratio for death of 1.54 (95% CI, 1.05-2.24) compared with those without.
  • Univariate analysis: men had a crude hazard ratio of 1.57 (95% CI, 1.03-2.37) compared with women.
  • Multivariate analysis: histologic type, age, CRP levels and leukocytosis were the independent predictors of worse survival. Asbestos exposure was not among them.
  • Multivariate analysis: non-epithelioid histology, compared with epithelioid, had an adjusted hazard ratio of 2.76 (95% CI, 1.50-5.08).
  • Multivariate analysis: age had an adjusted hazard ratio of 1.05 (95% CI, 1.01-1.08) per year.
  • Multivariate analysis, compared with CRP at or below 3 mg/L: CRP of 3-50 mg/L had an adjusted hazard ratio of 2.28 (95% CI, 1.18-4.42), and CRP above 50 mg/L had an adjusted hazard ratio of 2.69 (95% CI, 1.29-5.60).
  • Multivariate analysis: a white cell count above 12,000/mm3 had an adjusted hazard ratio of 2.28 (95% CI, 1.22-4.25).
• The authors' conclusion: The authors concluded that survival of patients with MPM remains poor. They found that systemic inflammation (raised CRP and white cell count), together with non-epithelioid histology and older age, independently predicted worse survival in patients not treated by curative surgery. They suggested that knowing these factors could help tailor treatment, but said this remains to be formally demonstrated.
• Limitations the authors state:
  • Because the study was retrospective, cause of death could not be assessed exactly, so only overall survival, not disease-specific survival, could be assessed.
  • Care after surgery varied, especially chemotherapy, which prevented rigorous survival analysis with respect to chemotherapy.

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, Pleurodesis, Asbestos Exposure, Chest X-Ray, Chemotherapy, Median Overall Survival, confidence interval, Overall Survival.

Related studies

• Can serum inflammatory parameters estimate outcome of pleurodesis in mesothelioma? — M. Bilgin, L. Hasdiraz, et al. (2007)
• Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis — B.S. Al-Alao, H. Parissis, et al. (2012)
• Reply to the editor — M. Baud, P. Forgez, et al. (2013)
• Survival and prognostic factors in malignant pleural mesothelioma: a retrospective study of 314 patients in the west part of Japan — S. Nojiri, K. Gemba, et al. (2011)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Pleurodesis outcome in malignant pleural mesothelioma — E.T. Fysh, S.K. Tan, et al. (2013)

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