Prognostic factors in malignant pleural mesothelioma: a retrospective study

Our plain-English summary of Prognostic factors in malignant pleural mesothelioma: a retrospective study, by H. Suzuki, T. Hirashima, M. Kobayashi, et al (Internal Medicine, 2012).

The study

• Authors: H. Suzuki, T. Hirashima, M. Kobayashi, N. Okamoto, Y. Matsuura, M. Tamiya, N. Morishita, K. Okafuji, T. Shiroyama, O. Morimura, S. Morita, I. Kawase
• Journal: Internal Medicine
• Published: 2012;51(7):707-10
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The incidence of malignant pleural mesothelioma (MPM) in Japan is predicted to increase over the next few decades. Prognostic factors remain unclear although several studies have reported this disease. In this study, we examined the prognostic factors of MPM from single institution practice data and tested the scoring systems of past reports.

Methods: We retrospectively obtained clinical data from the medical records of patients who were diagnosed with MPM from 1991 to 2010. The European Organization for Research and Treatment of Cancer prognostic score (EPS) was calculated.

Results: We surveyed the records of 68 patients. Univariate analysis showed that significant prognostic factors were histological type, stage, performance status (PS), chemotherapy, and lactate dehydrogenase (LD). Multivariate analysis identified stage, PS and LD as independent prognostic factors. Low-risk group (EPS ≤1.27) survival was significantly better than that of the high-risk group (EPS >1.27) (17.0 months vs. 8.0 months; p=0.002).

Conclusion: Stage, PS and LD were demonstrated to be independent prognostic factors. An EPS >1.27 was still considered a poor prognosis indicator in the practice data of MPM.

In plain English

This retrospective study reviewed the medical records of 68 patients diagnosed with malignant pleural mesothelioma from 1991 to 2010 at one hospital in Osaka, Japan. The authors looked for factors linked to survival and tested an existing prognostic score from the European Organization for Research and Treatment of Cancer (EORTC). When each factor was tested separately, tumor type (sarcomatous versus other types), disease stage, performance status (a measure of daily functioning), chemotherapy and blood lactate dehydrogenase (LD) level were significantly related to survival. Asbestos exposure, recorded in 43 patients, was not a statistically significant factor (p=0.863). When factors were analyzed together, stage, performance status and LD remained independent prognostic factors. Median survival for all patients was 15.5 months. Patients with a score of 1.27 or less had a median survival of 17.0 months, compared with 8.0 months for those scoring above 1.27 (p=0.002). The authors concluded that stage, performance status and LD were independent prognostic factors and that a score above 1.27 still indicated poor prognosis. They noted that the study was retrospective and small, and that it lacked data on weight loss and smoking.

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 study of medical records from a single institution, using Cox proportional hazards regression (one factor at a time, then several factors together) and Kaplan-Meier survival estimates
• Who was studied: 68 patients diagnosed with malignant pleural mesothelioma from 1991 to 2010 at the Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan; median age 68 years; 58 male and 10 female
• Exposure: Asbestos exposure was recorded as one of the candidate prognostic factors (yes or no). Obvious asbestos exposure was observed in 43 of the 68 patients. Fiber types and doses were not reported.
• Main results:
  • When each factor was tested separately, the significant prognostic factors were histological type, stage, performance status, chemotherapy and LD. Hazard ratios were: sarcomatous versus non-sarcomatous histology 4.201 [1.78-9.91], p=0.001; stage III or IV versus I or II 3.490 [1.72-7.09], p=0.0005; performance status 2.615 [1.38-4.97], p=0.0032; LD 2.579 [1.27-5.23], p=0.0085; chemotherapy 0.370 [0.19-0.72], p=0.0031.
  • In the separate-factor analysis, asbestos exposure (yes in 43 patients, no in 25) was not statistically significant: hazard ratio 1.057 [0.56-1.99], p=0.863.
  • In the multivariate analysis, stage, performance status and LD were independent prognostic factors: stage hazard ratio 2.965 [1.366-6.437], p=0.0060; performance status 2.447 [1.095-5.470], p=0.029; LD 2.987 [1.371-6.506], p=0.0059. Histology (p=0.071) and chest pain (p=0.054) were not statistically significant in this analysis.
  • Median survival time of all 68 patients was 15.5 months.
  • Patients in the low-risk group (EORTC score of 1.27 or less) survived significantly longer than patients in the high-risk group (score above 1.27): 17.0 months vs. 8.0 months, p=0.002.
• The authors' conclusion: The authors concluded that stage, performance status and LD were independent prognostic factors, and that an EORTC score above 1.27 was still a poor-prognosis indicator in everyday practice data on malignant pleural mesothelioma.
• Limitations the authors state:
  • The study was retrospective and had a small number of patients.
  • The patients studied were in worse condition than patients who take part in clinical trials.
  • Body weight loss and smoking history were not considered because of missing data.

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, Performance Status, Chemotherapy, Lactate Dehydrogenase (LDH), Multivariate Analysis, Prognosis.

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