Prognostic factors and treatment outcomes of malignant pleural mesothelioma in Eastern Asian patients - A Taiwanese study

Our plain-English summary of Prognostic factors and treatment outcomes of malignant pleural mesothelioma in Eastern Asian patients - A Taiwanese study, by T.H. Wu, L.J. Lee, C.T. Yuan, et al (Journal of the Formosan Medical Association = Taiwan Yi Zhi, 2019).

The study

• Authors: T.H. Wu, L.J. Lee, C.T. Yuan, T.W. Chen, J.C. Yang
• Journal: Journal of the Formosan Medical Association = Taiwan Yi Zhi
• Published: 2019;118(1 Pt 2):230-236
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/purpose: There are scarce reports on the prognostic factors and treatment outcomes of patients with malignant pleural mesothelioma (MPM) in Asia. This study aimed to address these matters in a real-world setting.

Methods: Medical records of patients with histologically proven MPM diagnosed between 1977 and 2016 at the National Taiwan University Hospital were reviewed. Variables including age, gender, performance status, asbestos exposure, smoking history, histology subtype, staging, and treatment received were recorded. All patients were followed until death or March 1st, 2017. Survival and prognostic factors were analyzed by the Kaplan-Meir method and the Cox proportional hazard model.

Results: A total of 93 patients was identified, including 65 men and 28 women. An increasing trend of MPM cases diagnosed was observed in the past 40 years. Stage I/II disease (HR 0.24, 95% CI 0.13-0.46) and epithelioid histology (HR 0.42, 95% CI 0.23-0.75) were associated with favorable prognosis, whereas age ≥70 years (HR 2.66, 95% CI 1.36-5.22) and ECOG ≥2 (HR 5.03, 95% CI 2.69-9.4) were poor prognostic factors. After adjustment for prognostic factors, surgery in stage I-III MPM (HR 0.36, 95% CI 0.15-0.83) and systemic therapy in stage III/IV disease (HR 0.42, 95% CI 0.19-0.94) conferred a survival benefit.

Conclusion: This is one of the largest case series of MPM reported in Asia outside of Japan. Prognostic factors in the study population included age, performance status, stage, and histology subtype. Surgery in potentially resectable disease and systemic therapy in advanced MPM confer a survival benefit in Asian patients.

Copyright © 2018. Published by Elsevier B.V.

In plain English

The authors reviewed the medical records of 93 patients with malignant pleural mesothelioma, a cancer of the chest lining, tissue-confirmed and diagnosed between 1977 and 2016 at National Taiwan University Hospital. Patients were followed until death or March 1, 2017. Cases diagnosed per five-year period rose over the 40 years. Median overall survival was 15.0 months (95% confidence interval 9.4 to 20.5) for all patients, 33.5 months (23.1 to 44.1) for stage I/II and 8.1 months (4.5 to 11.7) for stage III/IV disease. After statistical adjustment, early stage (I/II) and epithelioid tissue type were associated with longer survival. Age 70 or older and poorer physical condition (ECOG score 2 or higher) were associated with shorter survival. Patients recorded as asbestos-exposed (25 of 93) did not differ significantly in survival, but exposure information was missing for about 30% of patients. Surgery in stage I to III disease and drug therapy, mostly pemetrexed, in stage III/IV disease were associated with longer survival. The authors concluded these treatments would confer a survival benefit. They noted that the sample was small and came from a single hospital.

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 medical records (case series) with survival analysis
• Who was studied: 93 patients with histologically proven malignant pleural mesothelioma diagnosed 1977 to 2016 at National Taiwan University Hospital, Taiwan. Patients with non-pleural or combined pleural and peritoneal disease were excluded. Median age at diagnosis was 58 years. The article gives conflicting sex counts: 68 men and 25 women in the text, 65 and 28 in Table 1.
• Exposure: Asbestos exposure was recorded as a patient variable: yes for 25 (27%), no for 42 (45%), not available for 26 (28%). No fiber types, jobs or doses are reported. The study's main focus was prognostic factors and treatment (surgery, systemic therapy).
• Main results:
  • The number of cases diagnosed per five-year period increased from 1977 to 2016
  • Median overall survival for all patients was 15.0 months (95% CI 9.4 to 20.5)
  • Overall survival was 33.5 months (95% CI 23.1 to 44.1) for stage I/II and 8.1 months (95% CI 4.5 to 11.7) for stage III/IV
  • In multivariable analysis, stage I/II disease was associated with favorable prognosis (HR 0.24, 95% CI 0.13 to 0.46, p less than 0.001)
  • Epithelioid histology was associated with favorable prognosis (multivariable HR 0.42, 95% CI 0.23 to 0.75)
  • Age 70 or older was associated with poorer survival (multivariable HR 2.66, 95% CI 1.36 to 5.22, p 0.004)
  • ECOG performance status 2 or higher was associated with poorer survival (HR 5.03, 95% CI 2.69 to 9.4, p less than 0.001)
  • Asbestos exposure was not significantly associated with survival in univariate analysis (HR 0.85, 95% CI 0.48 to 1.50, p 0.566)
  • Of 66 stage I to III patients, 35 (53%) had surgery. After adjustment for age, stage, performance status and smoking, surgery was associated with favorable prognosis (HR 0.36, 95% CI 0.15 to 0.83).
  • Of 56 stage III/IV patients, 38 (68%) received systemic therapy, 33 of them pemetrexed. After adjustment for age, performance status and epithelioid histology, systemic therapy was associated with longer overall survival (HR 0.42, 95% CI 0.19 to 0.94).
• The authors' conclusion: The authors concluded that prognostic factors in these Asian patients were similar to those reported from high-prevalence countries. They also concluded that, after adjustment, surgery in potentially resectable disease and systemic therapy in advanced disease would confer a survival benefit.
• Limitations the authors state:
  • Relatively small sample size limited statistical power
  • Asbestos exposure information was missing for about 30% of patients, so its estimated effect on survival could be biased
  • The effect of multimodality therapy could not be evaluated because fewer than 10% of patients received it
  • Hospital-based rather than population-based, so not necessarily representative of mesothelioma patients in Taiwan or Eastern Asia
  • Age at asbestos exposure was not available, so the authors could not tell whether the younger age at diagnosis reflected earlier exposure or differences in latency

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, Performance Status, Asbestos Exposure, Histology, Staging, Epithelioid, Prognosis, Systemic Therapy.

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