Prognostic factors for progression-free and overall survival in malignant pleural mesothelioma

Our plain-English summary of Prognostic factors for progression-free and overall survival in malignant pleural mesothelioma, by J. Guzmán-Casta, S. Carrasco-CaraChards, J. Guzmán-Huesca, et al (Thoracic Cancer, 2021).

The study

• Authors: J. Guzmán-Casta, S. Carrasco-CaraChards, J. Guzmán-Huesca, C.P. Sánchez-Ríos, R. Riera-Sala, J.F. Martínez-Herrera, E.S. Peña-Mirabal, D. Bonilla-Molina, J.A. Alatorre-Alexander, L.M. Martínez-Barrera, J.R. Rodríguez-Cid
• Journal: Thoracic Cancer
• Published: 2021;12(7):1014-1022
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma is an infrequent neoplasia with a poor prognosis and the majority of patients already have advanced disease at the time of presentation. Exposure to asbestos is the most important risk factor for malignant pleural mesothelioma. Mesothelioma is a neoplasia with a long preclinical stage that can span from 15 to 40 years.

Methods: This was a descriptive, observational, retrospective study of 136 patients with a confirmed diagnosis of mesothelioma, which compared histological subtypes, immunohistochemical biomarkers, concomitant chronic degenerative diseases, tobacco use, age at the time of diagnosis, clinical stage and chemotherapy agents used or other treatments such as radiotherapy and surgery to identify all the factors that impact in the prognosis of overall survival (OS) and progression-free survival (PFS).

Results: A total of 136 patients were included in the study. In the total study population, 84 patients were male (61.8%) and 52 were female (38.2%). Median PFS was nine months (95% confidence interval [CI]: 8.4-9.5 months) and median OS was 12 months (95% CI: 11.3-12.6). The results indicated that the most determining prognostic factors for OS and PFS were cell differentiation measured by immunohistochemical biomarkers, the treatment chosen, and that RECIST was the most significant in the evaluation of patient response to treatment.

Conclusions: Malignant pleural mesothelioma is a cancer with a poor prognosis usually diagnosed at an advanced stage of disease. Our study revealed that the prognostic factors for OS and PS were cell differentiation, the treatment chosen and RECIST.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This retrospective study reviewed 136 adults with malignant pleural mesothelioma treated at the Instituto Nacional de Enfermedades Respiratorias in Mexico City. 84 were men and 52 women, average age 68, and 84 had stage IV disease. Almost all tumors (130) were epithelioid. Asbestos exposure was listed as a reviewed variable, but no asbestos findings were reported. Median progression-free survival (time before the disease worsened) was nine months (95% CI 8.4 to 9.5), and median overall survival was 12 months (95% CI 11.3 to 12.6). Most patients (81) received pemetrexed with carboplatin; their median overall survival was 13 months (95% CI 12.5 to 13.4). In single-factor analyses, surgery, several tissue markers, the chemotherapy used, RECIST treatment response and weight at diagnosis were statistically associated with survival. Analysed together, only RECIST response stood out. Its p-value was 0.051 for progression-free survival, which the authors called a tendency. For overall survival it was 0.06, which they called significant despite their stated cut-off of p less than 0.05. The authors concluded that cell differentiation, the treatment chosen and RECIST response were the main prognostic factors.

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: Descriptive, observational, retrospective study of patient records, with univariate and multivariate survival analyses
• Who was studied: 136 patients aged 18 or older with histologically confirmed malignant pleural mesothelioma, locally advanced and/or metastatic, at a public institute in Mexico City (Instituto Nacional de Enfermedades Respiratorias). 84 were male and 52 female, average age 68 (range 41 to 90), and 84 were at stage IV. 130 tumors were epithelioid, 3 sarcomatoid and 3 biphasic. The study period is not stated.
• Exposure: Not an asbestos exposure study. Asbestos exposure was listed as a reviewed variable, but no asbestos data or results are reported. The factors analysed were clinical, pathological and treatment factors: smoking, other diseases, immunohistochemical markers, stage, chemotherapy regimen, surgery, radiotherapy and weight.
• Main results:
  • All 136 patients: median progression-free survival 9 months (95% CI 8.4 to 9.5) and median overall survival 12 months (95% CI 11.3 to 12.6)
  • 81 patients (59.6%) received pemetrexed/carboplatin, the most used regimen. In this group, overall survival was 13 months (95% CI 12.5 to 13.4) and progression-free survival 10 months (95% CI 9.5 to 10.4).
  • Response to chemotherapy by RECIST 1.1 among the 136 patients: 25 (18.4%) partial response, 84 (61.8%) stable disease, 10 (7.4%) complete response, 17 (12.5%) progression
  • In univariate analysis, the 19 patients who had surgery showed statistically significant associations with progression-free survival (HR 0.66, P = 0.001) and overall survival (HR 0.57, P = 0.001)
  • In univariate analysis, the tissue markers nuclear WT1 (P = 0.036) and CK7 (P = 0.016) were statistically significant for progression-free survival. Nuclear calretinin (P = 0.024), cytoplasmic calretinin (P = 0.033) and CK7 (P = 0.012) were statistically significant for overall survival.
  • In multivariate analysis, RECIST response was the only variable to stand out. For progression-free survival P = 0.051, which the authors called a tendency towards significance. For overall survival P = 0.06, which the authors called statistically significant, although their stated significance threshold was P less than 0.05.
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma has a poor prognosis and is usually diagnosed at an advanced stage. In their view, the most determining prognostic factors for overall and progression-free survival were cell differentiation (measured by immunohistochemical markers), the treatment chosen, and RECIST response, which they considered the most significant.

Topics

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

Medical terms in this study, explained in our Lexicon: Overall Survival, Pleural Mesothelioma, Prognosis, Mesothelioma, Histological Subtype, Biomarker, Chemotherapy, Progression-Free Survival.

Related studies

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• Validation of Progression-Free Survival as a Surrogate Endpoint for Overall Survival in Malignant Mesothelioma: Analysis of Cancer and Leukemia Group B and North Central Cancer Treatment Group (Alliance) Trials — X. Wang, X. Wang, et al. (2017)
• Phase II study of first-line bortezomib and cisplatin in malignant pleural mesothelioma and prospective validation of progression free survival rate as a primary end-point for mesothelioma clinical trials (European Organisation for Research and Treatment of Cancer 08052) — M.E. O'Brien, R.M. Gaafar, et al. (2013)
• Preoperative Circulating Tumor DNA in Patients with Peritoneal Carcinomatosis is an Independent Predictor of Progression-Free Survival — J.M. Baumgartner, V.M. Raymond, et al. (2018)
• Prolonged Progression-Free Survival in a Patient With Malignant Pleural Mesothelioma Following Korean Herbal Medicine Treatment Alone: A Case Report — S.S. Yoon, E.H. Kim, et al. (2020)
• Survival prognostic factors in unresectable/advanced primary thoracic sarcomas — J.R. Rodriguez-Cid, J.J. Juarez-Vignon Whaley, et al. (2022)

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