Prognostic factors in malignant pleural mesothelioma

Our plain-English summary of Prognostic factors in malignant pleural mesothelioma, by B. Davidson (Human Pathology, 2015).

The study

• Author: B. Davidson
• Journal: Human Pathology
• Published: 2015;46(6):789-804
• Type of article: Review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a clinically aggressive tumor originating from mesothelial cells, which line the serosal cavities. Recent years have seen extensive research aimed at identifying new therapeutic targets, predictive markers and prognostic factors in this disease. These include both serum and tissue markers, and are related to multiple cellular pathways which affect cell survival, proliferation, apoptosis, angiogenesis, interaction with the immune response and DNA repair. Several of these molecules may become relevant for pathologists as part of the effort to select patient sub-populations for targeted therapy in the future. This review summarizes current data in this area and discusses their potential clinical relevance.

Copyright © 2015 Elsevier Inc. All rights reserved.

In plain English

This article is a review, not a new patient study. An author from the Department of Pathology at Oslo University Hospital, Norway, reviewed published research on biological factors that may predict survival or treatment response in malignant pleural mesothelioma. A PubMed search for "mesothelioma" and "prognostic" or "prognosis" produced over 2500 hits. Fewer than 5% of these had studied biological markers in at least 50 patients. The author regarded 50 as the minimum for reducing the risk of type II error (missing a real effect), but smaller studies were also discussed. The review covered serum and tissue markers involved in cell-surface signalling, blood-vessel growth, cell growth and death, the immune response, DNA repair and chemotherapy response, and gene-expression and sequencing studies. It summarized survival findings in tables. The author noted that tumor subtype is the most important known clinical factor: sarcomatoid and biphasic tumors are linked to worse outcome than epithelioid tumors. The author reported that many markers were studied in single, possibly underpowered reports, and that results for markers studied by several groups often conflicted. The author concluded that multi-institutional studies of large cohorts are needed.

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: Narrative literature review
• Who was studied: Published studies of patients with malignant pleural mesothelioma found by a PubMed search (over 2500 hits). Fewer than 5% of the hits studied biological markers in series of at least 50 patients, the number the author regarded as the minimum for reducing the risk of type II error. Some smaller studies were also discussed.
• Exposure: Not an asbestos exposure study. The review examined serum and tissue biological markers in relation to patient outcome. No fiber types were studied.
• Main results:
  • The author described tumor histological subtype as the most important clinicopathologic factor. Sarcomatoid and biphasic mesothelioma were associated with significantly worse outcome than epithelioid mesothelioma.
  • Many of the molecules reviewed had been studied in only single reports, some possibly of insufficient power. For biomarkers studied by several groups, results were often conflicting.
  • Most of the reviewed studies included all histological subtypes of malignant pleural mesothelioma rather than epithelioid tumors alone.
  • The review also discussed studies with fewer than 50 tumors, for example a gene-expression study of 17 mesotheliomas.
  • The author judged that a 2005 prediction that targeted therapy would change patient care had, ten years later, not been realized.
• The authors' conclusion: The author concluded that the solution lies in multi-institutional studies of large cohorts, in which subgroups of patients with similar histology and treatment can be analyzed separately. The author also concluded that pathologists have a central role in this work.
• Limitations the authors state:
  • The author stated that differences between the reviewed studies in gender, histology, stage and treatment of cases, and in methods, likely contributed to their conflicting results.
  • The author noted that because long-term survival is rare in this disease, it is difficult to identify biological factors that clearly separate patients with poor and better survival.

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, Mesothelial Cells, Apoptosis, Angiogenesis, Targeted Therapy.

Related studies

• Circulating endothelial cell (CEC) as a diagnostic and prognostic marker in malignant pleural mesothelioma (MPM) — K. Yoneda, F. Tanaka, et al. (2012)
• Brain-derived neurotrophic factor, a new soluble biomarker for malignant pleural mesothelioma involved in angiogenesis — P. Smeele, S.M. d'Almeida, et al. (2018)
• 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)
• Mesothelin-related predictive and prognostic factors in malignant mesothelioma: a nested case-control study — O.D. Roe, J. Creaney, et al. (2008)
• Pleural effusion VEGF levels as a prognostic factor of malignant pleural mesothelioma — N. Hirayama, C. Tabata, et al. (2011)
• Mesothelin expression is a prognostic factor in cholangiocellular carcinoma — R. Nomura, H. Fujii, et al. (2013)

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