Prognostic significance of flow cytometric DNA analysis in patients with malignant pleural mesothelioma

Our plain-English summary of Prognostic significance of flow cytometric DNA analysis in patients with malignant pleural mesothelioma, by S. Emri, H. Akbulut, F. Zorlu, et al (Lung Cancer, 2001).

The study

• Authors: S. Emri, H. Akbulut, F. Zorlu, D. Dinçol, H. Akay, Y. Güngen, F. Içli
• Journal: Lung Cancer
• Published: 2001;33(2-3):109-14
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) due to environmental exposure to asbestos and erionite is a relatively common cancer in Turkey. In this study, we investigated the value of flow cytometric (FCM) DNA analysis and other prognostic factors such as age and etiologic factor in the patients with MPM, treated with surgery+/-combination chemotherapy+/-radiotherapy. A total of 40 patients with a median age of 50 (range 30-68) were included in the study. Twenty-nine patients had asbestos exposure in etiology, while 11 had fibrous zeolite (erionite). Paraffin-embedded tumor specimens were studied by FCM for DNA analysis. Twelve patients (30%) had aneuploid tumors and 28 (70%) had diploid ones. Mean S-phase fraction (SPF; %) was 9.1+/-1.1 and proliferation index (PI, SPF+G2/M phase; %) was 11.3+/-0.9. While the median overall survival (OS) was 10+/-2 months (6-14; 95% CI), 1-year survival rate was 45.2%. Only PI was found to be statistically significant for OS in univariate analysis (P=0.013). PI was also found to be an independent prognostic factor for all patients (P=0.035). Aneuploidy was significantly higher in erionite group compared with asbestos group. Male predominance and poor survival were also prominent in erionite group, though not statistically significant. In conclusion, PI is an independent prognostic factor for patients with MPM and the biologic features of the disease may show differences with respect to different etiologies.

In plain English

This study from Turkey asked whether DNA analysis of tumor cells (flow cytometry) could help predict survival in malignant pleural mesothelioma. The authors analysed tumor samples from 40 patients with epithelial pleural mesothelioma. Twenty-nine came from asbestos regions of Turkey and 11 from Cappadocian villages with the fibrous mineral erionite. All had surgery, but no curative resection was possible in any patient. Twenty-five received combination chemotherapy. Median overall survival was 10 months (95% confidence interval 6 to 14 months), and one-year survival was 45.2%. Twelve patients (30%) had tumors with abnormal DNA content (aneuploid). Only the proliferation index, a measure of dividing tumor cells, was statistically significant for overall survival (P=0.013). It was also an independent prognostic factor in multivariate analysis (P=0.035). Aneuploidy was significantly more common in the erionite group (72.7%) than in the asbestos group (13.8%). Survival was poorer in the erionite group, but the difference was not statistically significant. The authors concluded that the proliferation index is an independent prognostic factor, that the disease's biology may differ by cause, and that larger prospective studies 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: Clinical study of 40 treated patients: flow cytometric DNA analysis of paraffin-embedded tumor specimens, with survival analysis (Kaplan–Meier, log-rank, Cox multivariate regression)
• Who was studied: 40 patients with epithelial malignant pleural mesothelioma in Turkey (14 female, 26 male; median age 50, range 30–68): 29 from asbestos regions and 11 from erionite villages in Cappadocia. All had T3–T4 tumors without distant metastases. Study dates not given.
• Exposure: Environmental exposure to asbestos (fiber type not specified) in 29 patients, or to the fibrous zeolite erionite in 11 patients. No doses given.
• Main results:
  • All 40 patients: median overall survival 10 months (95% CI 6–14), printed as '102' because the plus-minus sign was lost. One-year survival rate 45.2%.
  • All patients: 12 (30%) had aneuploid tumors and 28 (70%) had diploid tumors.
  • All patients: only the proliferation index was statistically significant for overall survival in univariate analysis (P=0.013). It was also an independent prognostic factor (P=0.035).
  • Type of surgery and chemotherapy were not significant factors for survival. Aneuploidy was also not a significant factor for survival.
  • Aneuploidy was significantly more common in the erionite group (72.7%) than in the asbestos group (13.8%), P=0.0007.
  • Erionite group: male predominance and poorer survival, neither statistically significant (survival comparison P=0.846).
  • Patients who received chemotherapy (25): overall objective response rate 20%.
• The authors' conclusion: The authors concluded that the proliferation index is an independent prognostic factor in malignant pleural mesothelioma. They also concluded that the disease's biologic features may differ according to its cause (asbestos or erionite).
• Limitations the authors state:
  • The authors state that prospective studies with large numbers of patients are needed to clarify the value of flow cytometry in this disease.
  • The authors state that larger numbers of erionite-exposed patients, managed with standard protocols, are needed to clarify the survival difference by cause.

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, Environmental Exposure, erionite, Chemotherapy, Asbestos Exposure, Etiology, Zeolite, Median Overall Survival.

Related studies

• DNA analysis by flow cytometry in malignant pleural mesothelioma: relationship to histology and survival — H. Dazzi, N. Thatcher, et al. (1990)
• Localized fibrous tumor of the serosal cavities. Immunohistochemical, electron-microscopic, and flow-cytometric DNA study — A.K. el-Naggar, J.Y. Ro, et al. (1989)
• Flow cytometric analysis of ploidy in immunohistochemically confirmed examples of malignant epithelial mesothelioma — H.F. Frierson, S.E. Mills, et al. (1988)
• Flow cytometric analysis of a localized malignant mesothelioma — J.J. Gómez-Román, R. Mons-Lera, et al. (2002)
• Flow cytometric measurement of cellular FLICE-inhibitory protein (c-FLIP) in ovarian carcinoma effusions — H.P. Dong, A.K. Ree Rosnes, et al. (2011)
• Prognostic significance of Bax and Fas ligand in erionite and asbestos induced Turkish malignant pleural mesothelioma — N. Kokturk, P. Firat, et al. (2005)

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