Prognostic factors affecting survival in malignant pleural mesothelioma: analysis of 125 subjects

Our plain-English summary of Prognostic factors affecting survival in malignant pleural mesothelioma: analysis of 125 subjects, by B. Komurcuoglu, A.K. Cirak, S.C. Kirakli, et al (Tumori, 2014).

The study

• Authors: B. Komurcuoglu, A.K. Cirak, S.C. Kirakli, G. Polat, N. Yucel, O. Usluer, O. Erer, G. Balci, M. Gayaf, F. Guldaval, S. Aktogu, S. Guclu, A. Ozsoz, H. Halilcolar
• Journal: Tumori
• Published: 2014;100(1):55-9
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim Of The Study: Determining the pre-treatment prognostic factors in malignant pleural mesothelioma is important in terms of estimating the course of the disease and selecting patients who are candidate for multimodal therapy. The aim of the study was to determine the prognostic factors affecting survival in patients with malignant pleural mesothelioma.

Study Design: One hundred and twenty-five patients who had been diagnosed histologically as having malignant pleural mesothelioma over the past 5 years were evaluated retrospectively. Relationships of survival of the patients with their age, gender, exposure to asbestos, smoking history, platelet, hemoglobin, leukocyte (WBC) and serum LDH values, histology, performance score and stage of disease were examined.

Results: Advanced clinical stage, N2 nodal involvement and the presence of distant metastasis were found to be related to survival. Sarcomatous histology was found to be a poor prognostic factor independently of other factors.

Conclusions: We showed that histological subtype and stage of disease were the most important parameters in planning the treatment, especially in determining the patients who were candidate for multimodal treatment and in estimating the prognosis.

In plain English

This study looked back at the hospital records of 125 patients diagnosed with malignant pleural mesothelioma between 2005 and 2010 at a respiratory diseases and thoracic surgery hospital in Izmir, western Turkey. The aim was to find which factors were linked to survival. There were 59 men and 66 women. The text says 71 patients (57%) had a history of occupational asbestos exposure, while a table lists 82 (66%) with asbestos exposure. Median overall survival was 9 months. No statistically significant relationship was found between a history of asbestos exposure and survival. In the final statistical model, three factors were linked to shorter survival: stage III disease (hazard ratio 8.11, 95% CI 3.89-16.87), stage IV disease (hazard ratio 25.7, 95% CI 12-55) and the sarcomatous tissue subtype (hazard ratio 2.27, 95% CI 1.28-4.03). Patients with N2 lymph node involvement survived a shorter time than those with N0. The authors concluded that sarcomatous histology was an independent poor prognostic factor. Some figures in the article contradict each other.

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 review of hospital records (the authors also call the study cross-sectional), with survival analysis (Kaplan-Meier, logrank test, Cox regression)
• Who was studied: 125 patients with malignant pleural mesothelioma diagnosed between 2005 and 2010 at the Dr Suat Seren Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Izmir, western Turkey; 59 men and 66 women, median age 61
• Exposure: History of asbestos exposure, recorded as one of several factors tested against survival. The text reports 71 patients (57%) with occupational exposure; Table 1 lists 82 (66%) with asbestos exposure. The authors also mention environmental exposure in patients from neighboring cities. In the discussion they attribute the many female patients to housewives' use of soil containing white asbestos in house whitewash.
• Main results:
  • Median overall survival for all 125 patients was 9 months (range given as 6-15)
  • No significant relationship between a history of asbestos exposure and survival in univariate analysis (P = 0.42) or multivariate analysis (P = 0.13)
  • Being in stage III was linked to shorter survival: hazard ratio 8.11 (95% CI 3.89-16.87), P less than 0.0001
  • Being in stage IV was linked to shorter survival: hazard ratio 25.7 (95% CI 12-55), P less than 0.0001
  • Sarcomatous subtype was linked to shorter survival independently of other factors: hazard ratio 2.27 (95% CI 1.28-4.03), P = 0.005. Of the patients, 73% had the epithelial subtype, 14% sarcomatous and 13% mixed. Epithelial patients survived longer than sarcomatous patients (logrank p = 0.026).
  • Patients with N0 nodal involvement survived 12 months (plus or minus 1.56), compared with 5.9 months (plus or minus 4.06) for patients with N2 involvement, P = 0.029 (reported as multivariate)
  • Table 1 gives a hazard ratio for anemia of 1.88 (95% CI 1.18-2.99, P = 0.008), and the results text says anemia was significantly related to mortality. The discussion, however, states that no relationship with anemia could be shown.
• The authors' conclusion: The authors concluded that their series, in which women predominated, was consistent with the literature: sarcomatous histology is an independent poor prognostic factor, and advanced clinical stage and N2 nodal involvement are associated with short survival
• Limitations the authors state:
  • The effect of treatments on survival could not be examined because too few patients were in each treatment group
  • Few patients had distant metastasis
  • Too few radical surgeries were performed to compare survival by side of the chest involved
  • The authors attribute the relatively short survival to the small number of patients receiving multimodal treatment

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, Multimodal Therapy, Histology, Metastasis, Histological Subtype, Prognosis.

Related studies

• 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 influencing survival in 35 patients with malignant peritoneal mesothelioma — H. Kaya, C. Sezgı, et al. (2014)
• Validation of prognostic factors in malignant pleural mesothelioma: a retrospective analysis of data from patients seeking compensation from the New South Wales Dust Diseases Board — S.C. Kao, J. Vardy, et al. (2013)
• Prognostic factors in malignant pleural mesothelioma: a retrospective study — H. Suzuki, T. Hirashima, et al. (2012)
• A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2010)
• A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index — Y. Kataoka, Y. Yamamoto, et al. (2015)

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