Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients

Our plain-English summary of Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients, by E. Chailleux, G. Dabouis, D. Pioche, et al (Chest, 1988).

The study

• Authors: E. Chailleux, G. Dabouis, D. Pioche, M. de Lajartre, A.Y. de Lajartre, A. Rembeaux, P. Germaud
• Journal: Chest
• Published: 1988;93(1):159-62
• Cited by: 102 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000199).

Abstract

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.

In plain English

This retrospective study reviewed 167 cases of diffuse malignant pleural mesothelioma diagnosed from 1955 to 1985 near Nantes and St. Nazaire, France. Patients were 159 men and eight women, mean age 62. Occupational asbestos exposure was judged certain in 120 cases, probable in 19 and not a factor in 19; shipbuilding was the commonest industry (96 cases). Survival from first symptoms was 54 percent at one year and 22 percent at two years. Survival from histologic diagnosis, excluding autopsy diagnoses, was 39 percent at one year and 14 percent at two years. No patient lived four years past diagnosis. Cell type and asbestos exposure did not predict survival. Median survival from first symptoms was longer for patients aged 60 or under, for left-sided tumors, and when diagnosis came over two months after first symptoms. Treated patients survived significantly longer than untreated patients, even after adjusting for age. Survival did not differ significantly between treatment types. The authors concluded the disease's course remained rapid and unfavorable. The retrospective design, they noted, meant treated patients' longer survival could not be attributed solely to therapy.

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 case series with survival analysis (actuarial method, log-rank test)
• Who was studied: 167 cases of diffuse malignant pleural mesothelioma diagnosed 1955 to 1985 in the Loire-Atlantique area (largely Nantes-St. Nazaire), France. Patients were 159 men and eight women, mean age 62 (range 21 to 86).
• Exposure: Occupational asbestos exposure was certain in 120 cases (76 percent), probable in 19 and not a factor in 19. Shipbuilding was the most common industry (96 cases). Median length of exposure was 24 years, and the median interval from first exposure to diagnosis was 43 years. Fiber types were not reported for the series as a whole. The authors mention a separate case-control study of 20 cases from this series that found a high number of asbestos fibers, especially crocidolite, in lung tissue.
• Main results:
  • Whole series (n = 167): survival from first symptoms was 54 percent at one year and 22 percent at two years, with a median of 13 months
  • Autopsy diagnoses excluded (n = 157 per Figure 1): survival from histologic diagnosis was 39 percent at one year and 14 percent at two years, with a median of ten months
  • No patient was alive four years after diagnosis
  • Histologic type and asbestos exposure had no predictive value for survival
  • Age: median survival from first symptoms was 12 months for patients over 60 and 17 months for those 60 or younger
  • Side: the right side was involved in 105 cases and the left in 61 (p less than 0.001). Median survival from first symptoms was 18 months for left-sided tumors and 12 months for right-sided tumors.
  • When more than two months passed between onset of symptoms and diagnosis, median survival counted from first symptoms was 16 months, compared with 8 months for a shorter delay
  • Patients treated by chemotherapy, surgery or talc poudrage survived significantly longer than untreated patients. Per the text, median survival from diagnosis was 12 months for treated patients and seven months for untreated patients.
  • The effect of treatment remained significant after adjustment for age (treated patients were younger than untreated patients)
  • Survival did not differ statistically between patients treated by surgery, chemotherapy, talc poudrage or a combination of treatments
• The authors' conclusion: The authors concluded that despite treatment attempts, the course of diffuse malignant pleural mesothelioma remained rapid and unfavorable. They found that the prognostic differences they observed lost significance within three years of diagnosis. They also said their experience did not suggest that one means of therapy was superior to others.
• Limitations the authors state:
  • Because the study was retrospective, the authors could not attribute the better survival of treated patients solely to therapy
  • Patients could not be classified accurately by the proposed staging schemas because the data were heterogeneous

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, Occupational Exposure, Asbestos Exposure, Mesothelioma, Chemotherapy, Talc.

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