Prognosis and prognostic factors of patients with mesothelioma: a population-based study

Our plain-English summary of Prognosis and prognostic factors of patients with mesothelioma: a population-based study, by S. van der Bij, H. Koffijberg, J.A. Burgers, et al (British Journal of Cancer, 2012).

The study

• Authors: S. van der Bij, H. Koffijberg, J.A. Burgers, P. Baas, M.J. van de Vijver, B.A. de Mol, K.G. Moons
• Journal: British Journal of Cancer
• Published: 2012;107(1):161-4
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: It is important to regularly update survival estimates of patients with malignant mesothelioma as prognosis may vary according to epidemiologic factors and diagnostic and therapeutic management.

Methods: We assessed overall (baseline) survival as well as related prognostic variables in a large cohort of 1353 patients with a confirmed diagnosis of malignant mesothelioma between 2005 and 2008.

Results: About 50% of the patients were 70 years or older at diagnosis and the median latency time since start of asbestos exposure was 49 years. One year after diagnosis, 47% of the patients were alive, 20% after 2 years and 15% after 3 years. Prognostic variables independently associated with worse survival were: older age (HR=1.04 per year 95% CI (1.03-1.06)), sarcomatoid subtype (HR=2.45 95% CI (2.06-2.90)) and non-pleural localisation (HR=1.67 95% CI (1.26-2.22)).

Conclusion: Survival of patients with malignant mesothelioma is still limited and depends highly on patient age, mesothelioma subtype and localisation. In addition, a substantial part of the patients had a long latency time between asbestos exposure and diagnosis.

In plain English

This retrospective analysis used a Dutch registry of 1353 people with malignant mesothelioma who applied to the Dutch institute for asbestos victims for compensation between 2005 and 2008. Most were men (91%), 96% had pleural mesothelioma, and the median time from first asbestos exposure to diagnosis was 49 years. Median survival was 333 days (95% CI 309 to 368). 47% lived longer than 1 year, 20% more than 2 years, and less than 15% were alive at 3 years, against 90% of people of similar age and gender in the general Dutch population. After adjusting for other factors, worse survival was associated with older age (hazard ratio 1.04 per year, 95% CI 1.03 to 1.06), sarcomatoid rather than epithelial subtype (2.45, 95% CI 2.06 to 2.90) and non-pleural, mostly peritoneal, tumours compared with pleural (1.67, 95% CI 1.26 to 2.22). The authors concluded that survival remains poor and depends highly on age, subtype and location. They noted that exposure information was mainly self-reported and that factors such as general well-being and weight loss were not available.

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 cohort analysis of an existing registry (described by the authors as a population-based study), using survival analysis and Cox regression
• Who was studied: 1353 patients with malignant mesothelioma in the Netherlands who applied to the Dutch institute for asbestos victims and entered the financial compensation process between 2005 and 2008. Mean age at diagnosis was 69 years and 91% were male. 96% had pleural tumours. The 57 non-pleural cases were peritoneal except one pericardial case.
• Exposure: Asbestos exposure characteristics, mainly self-reported: duration of exposure, latency time from first exposure to diagnosis, and direct exposure (yes or no). No fiber types were reported. 78% had a history of direct exposure. Latency ranged from 19 to 78 years, with a median of 49 years.
• Main results:
  • In the whole cohort, median survival was 333 days (95% CI: 309–368). 47% survived longer than 1 year and 20% more than 2 years.
  • Less than 15% of the cohort was alive 3 years after diagnosis, compared with 90% of people with similar age and gender distribution in the general Dutch population.
  • In the multivariable model, only age, pathologic subtype and tumour location were significantly and independently associated with survival.
  • Older age was associated with worse survival: adjusted HR 1.04 per year (95% CI 1.03–1.06).
  • Sarcomatoid subtype, compared with epithelial subtype, was associated with worse survival: adjusted HR 2.45 (95% CI 2.06–2.90).
  • Non-pleural (peritoneal, plus one pericardial) location, compared with pleural location, was associated with worse survival: adjusted HR 1.67 (95% CI 1.26–2.22).
  • The authors did not observe a significant association between asbestos exposure characteristics and survival. However, the table shows an adjusted HR of 1.28 (95% CI 1.02–1.61), marked significant at P 0.05, for exposure duration of 30 years or more compared with less than 5 years.
  • Predicted 1-year survival for pleural epithelial mesothelioma was 77% for a patient aged 50 and 38% for a patient aged 80. For pleural sarcomatoid mesothelioma it was 53% at age 50 and 9% at age 80.
  • The combined model's discrimination was a c-statistic of 0.66 (95% CI: 0.64–0.68), which the authors described as moderate.
• The authors' conclusion: The authors concluded that overall survival in malignant mesothelioma remains poor and depends highly on patient age, subtype and tumour location. They also concluded that half the patients were 70 or older and a substantial part had a long latency time since asbestos exposure.
• Limitations the authors state:
  • Not all potentially relevant predictors were available. General well-being and weight loss, for example, were missing.
  • Asbestos exposure information was mainly self-reported, so it may be of lower quality than the other predictors.
  • Comparisons with older Dutch studies are hard to make if the mix of patients has changed over time.

Topics

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

Medical terms in this study, explained in our Lexicon: Prognosis, Mesothelioma, Latency, Asbestos Exposure, Sarcomatoid.

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