Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis

Our plain-English summary of Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis, by B.S. Al-Alao, H. Parissis, I.J. Rychlik, et al (Asian Cardiovascular & Thoracic Annals, 2012).

The study

• Authors: B.S. Al-Alao, H. Parissis, I.J. Rychlik, A. Graham, J. McGuigan
• Journal: Asian Cardiovascular & Thoracic Annals
• Published: 2012;20(4):443-9
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To examine baseline characteristics associated with survival in patients with malignant pleural mesothelioma.

Methods: 122 patients with histologically proven malignant pleural mesothelioma during the period 2000-2010 were studied. Survival was evaluated by the Kaplan-Meier method with the logrank test. Cox regression analysis was used to estimate the hazard ratios for possible prognostic factors.

Results: 105 (86%) patients had complete survival follow-up; 91 died and 14 (13.3%) were alive at the end of the observation period starting from the day of diagnosis. The median survival was 286 days (95% confidence interval: 212-359). Talc pleurodesis was performed in 59 patients, and 17 had surgical interventions (2 chest wall resections, 2 extrapleural pneumonectomies, and 13 decortications). Chemotherapy was used in 41 patients, port-site radiation in 68, and combined therapy in 26. Cox regression analysis identified talc pleurodesis (p=0.04), chemotherapy (p<0.001), port-site radiation (p<0.001), and combined chemotherapy and port-site radiation (p<0.006) as favorable prognostic factors after adjusting for age, sex, histologic subtype, smoking, and performance status.

Conclusions: Surgical intervention including decortications and extrapleural pneumonectomy had no effect on survival in this series. Chemotherapy and radiation to port sites independently and in combination were associated with improved overall survival in malignant pleural mesothelioma patients. Talc pleurodesis was an independent determinant of survival, but further studies are warranted.

In plain English

The authors reviewed data from one institution on 122 patients with histologically proven malignant pleural mesothelioma seen during 2000 to 2010, looking for factors linked to survival. Of these patients, 45 reported occupational asbestos exposure, 18 incidental exposure and 22 no exposure. Among 105 patients with complete follow-up, 91 died. Median overall survival was 9 months (95% confidence interval 6.4 to 11.7 months). One-year survival was 41.8% and two-year survival was 13%. Patients who had talc pleurodesis had a median survival of 12 months, compared with 6 months for patients who had no treatment (p = 0.008). The authors then adjusted for age, sex, histologic subtype, smoking and performance status. In that analysis, talc pleurodesis, chemotherapy, port-site radiation and combined chemoradiation were each associated with better survival, while surgical management was not. The authors concluded that talc pleurodesis was an independent determinant of survival but that further studies are warranted. They cautioned that selection bias may account for the apparent talc benefit and that unknown confounders may have influenced the results.

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: Single-institution retrospective analysis of prospectively collected data (survival analysis)
• Who was studied: 122 patients with histologically proven pleural malignant mesothelioma, 2000 to 2010, at one institution (the authors' department is at the Royal Victoria Hospital, Belfast, UK)
• Exposure: Self-reported asbestos exposure was 45 occupational, 18 incidental and 22 none. The study's focus was on treatments (talc pleurodesis, surgery, chemotherapy, port-site radiation) and patient characteristics as predictors of survival.
• Main results:
  • Of 122 patients, 105 (86%) had complete survival follow-up. Of these, 91 died and 14 (13.3%) were alive at the end of observation.
  • Median overall survival for all patients was 9 months (95% CI 6.4 to 11.7).
  • Overall 1-year survival was 41.8% and 2-year survival was 13%.
  • Patients given talc pleurodesis had a median survival of 12 months versus 6 months for patients with no treatment (p = 0.008). There was no difference compared with other surgical interventions (p = 0.77).
  • In the multivariate Cox analysis, the estimate for talc pleurodesis was 0.618 (95% CI 0.390 to 0.981), p = 0.041. The table labels this column 'Odds ratio'.
  • In the multivariate analysis, the estimate for chemotherapy was 0.123 (95% CI 0.042 to 0.362), printed as p = 0.000.
  • In the multivariate analysis, the estimate for port-site radiation was 0.300 (95% CI 0.149 to 0.604), p = 0.001.
  • In the multivariate analysis, the estimate for combined chemoradiation was 0.202 (95% CI 0.065 to 0.627), p = 0.006.
  • In the multivariate analysis, surgical management was not statistically significant: 1.151 (95% CI 0.516 to 2.567), p = 0.731.
  • In the unadjusted (survival curve) comparison, port-site radiation alone showed only a trend toward significance.
• The authors' conclusion: The authors concluded that surgical intervention had no effect on survival in this series, and that chemotherapy and port-site radiation, alone and combined, were associated with improved overall survival. They concluded that talc pleurodesis was an independent determinant of survival but that further studies are warranted.
• Limitations the authors state:
  • Because the analysis was retrospective, some patient information may be lacking, and unknown confounders may have influenced the outcome.
  • Selection bias may explain the apparent survival benefit with talc pleurodesis.
  • Tumor staging was not routinely done, so results could not be stratified by TNM stage.
  • Patients received various therapies in various combinations and for different durations, so survival benefits attributed to treatments must be interpreted with caution.
  • The data on extrapleural pneumonectomy were insufficient to draw conclusions.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Talc Pleurodesis, Hazard Ratio, Median Overall Survival, confidence interval, Chemotherapy, Histological Subtype, Performance Status.

Related studies

• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)
• Talc slurry pleurodesis. Pleural fluid and histologic analysis — L. Kennedy, R.A. Harley, et al. (1995)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)

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