Prognostic Value of Chest CT Volumetric Analysis in Patients with Malignant Pleural Mesothelioma

Our plain-English summary of Prognostic Value of Chest CT Volumetric Analysis in Patients with Malignant Pleural Mesothelioma, by E. Baratella, E. Ercolani, A. Segalotti, et al (Journal of Clinical Medicine, 2025).

The study

• Authors: E. Baratella, E. Ercolani, A. Segalotti, M. Troian, S. Lovadina, F. Giudici, P. Minelli, B. Ruaro, F. Salton, M.A. Cova
• Journal: Journal of Clinical Medicine
• Published: 2025;14(5)
• Read it: PubMed · Publisher · Free full text

Abstract

Background/Objectives: Malignant pleural mesothelioma (MPM) is a rare, aggressive cancer linked to asbestos exposure and with poor overall survival. In recent years, CT volumetric analysis has gained increasing interest as a more accurate method for assessing tumor burden. This study aims to evaluate the prognostic value of chest CT volumetric analysis in MPM, comparing tumor volume with tumor thickness measurements and survival outcomes. Methods: This is a retrospective, observational analysis of all patients undergoing diagnostic thoracoscopy between 2014 and 2021 at the University Hospital of Cattinara (Trieste, Italy). Inclusion criteria were as follows: age ≥ 18 years, histological diagnosis of MPM, and the availability of at least one contrast-enhanced chest CT scan at the time of diagnosis. For each patient, the tumor thickness was measured on the axial plane at three levels (upper, middle, and lower hemithorax). Tumor and effusion volumes were calculated with the RayStation® software version 11.7.174 (HealthMyne®, Madison, WI, USA). Results: A total of 81 patients were eligible for analysis. Maximum and mean tumor thickness were strongly associated with survival, with higher thicknesses correlating with an increased risk of death (adjusted hazard ratio per doubling (aHR) of 1.97 (95%CI: 1.40-2.77) and of 2.23 (95%CI: 1.56-3.20), p < 0.001)), respectively, while the effect of the tumor volume on survival was nevertheless significant but less impactful (aHR = 1.26 (1.10-1.45, p < 0.001)). The presence and volume of effusion did not correlate with survival (p = 0.48 and p = 0.64, respectively). Conclusions: This study supports the role of quantitative parameters for staging MPM, particularly given the frequent discrepancies between clinical and pathological staging when relying solely on qualitative measures.

In plain English

This retrospective, single-hospital study in Trieste, Italy, examined whether chest CT measurements taken at diagnosis were linked to survival in malignant pleural mesothelioma. It included 81 patients diagnosed through thoracoscopy between 2014 and 2021. Asbestos exposure was confirmed for 67 of them (82.7%). Radiologists measured tumor thickness at three levels of the chest, and software calculated tumor and pleural effusion volumes. Median survival for the 81 patients was 13.3 months (95% CI 10.2 to 17.6), and 77 had died by the last follow-up. The authors adjusted for age, sex, T stage, tissue subtype and treatment. After that adjustment, each doubling of maximum tumor thickness was associated with a hazard ratio for death of 1.97 (95% CI 1.40 to 2.77). For mean thickness the figure was 2.23 (1.56 to 3.20), and for tumor volume it was 1.26 (1.10 to 1.45). The presence and volume of pleural effusion did not correlate with survival. The authors concluded that tumor thickness was associated with prognosis. They wrote that tumor volume showed a potential correlation that they could not demonstrate clearly. They listed the retrospective design and small sample size as limitations.

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, observational, single-centre (monocentric) study of chest CT measurements and survival
• Who was studied: 81 adults with histologically confirmed malignant pleural mesothelioma and a contrast-enhanced chest CT at diagnosis. They were drawn from 400 patients who underwent diagnostic thoracoscopy at the University Hospital of Cattinara, Trieste, Italy, between 2014 and 2021, of whom 134 were diagnosed with MPM. There were 73 men and 8 women, median age 73.
• Exposure: The study examined CT-measured tumor thickness (maximum and mean of three levels), tumor volume and pleural effusion volume. Asbestos exposure was recorded as confirmed in 67 patients (82.7%), uncertain in 10 (12.3%) and virtually absent in 4 (4.9%). No fiber types were reported.
• Main results:
  • Median survival for the 81 patients, of whom 77 had died, was 13.3 months (95% CI 10.2 to 17.6).
  • The multivariable model was adjusted for age, sex, T parameter, histologic subtype and treatment. In it, the hazard ratio for death per doubling was 1.97 (95% CI 1.40 to 2.77) for maximum thickness, 2.23 (1.56 to 3.20) for mean thickness and 1.26 (1.10 to 1.45) for tumor volume, all with p less than 0.001.
  • In unadjusted (univariable) analysis, the hazard ratio per doubling was 1.55 (95% CI 1.22 to 1.96) for maximum thickness, 1.54 (1.21 to 1.95) for mean thickness and 1.19 (1.08 to 1.32) for tumor volume.
  • The presence and the volume of pleural effusion were not associated with survival (p = 0.478 and p = 0.636).
  • Patients with T3 to T4 tumors had a median overall survival of 10.9 months, compared with 17.7 months for T1 to T2 (p = 0.035).
  • Using cut-offs derived from the study data, patients with mean thickness above 5.1 mm had a median survival of 11.95 months, versus 30.21 months below that cut-off (p = 0.003).
  • Patients with maximum thickness above 10.3 mm had a median survival of 11.67 months, versus 22.68 months below that cut-off (p = 0.008).
  • Patients with tumor volume below 4.3 mL had a median survival of 33.07 months, versus 12.23 months for higher volumes (p = 0.002).
  • Tumor volume correlated with mean thickness (r = 0.69) and with maximum thickness (r = 0.74).
• The authors' conclusion: The authors concluded that an association between tumor thickness and prognosis had emerged. They wrote that tumor volume showed a potential correlation with prognosis that they were unable to demonstrate clearly. They also wrote that their study strongly rejects a link between survival and pleural effusion volume, and that quantitative parameters should be seriously considered for staging MPM.
• Limitations the authors state:
  • The retrospective design may affect how far the findings can be generalized and how robust they are.
  • The small sample size may limit statistical power.
  • Tumor tissue was often hard to distinguish from collapsed lung (atelectasis) during volume segmentation.
  • The authors stated that the cut-off findings require validation in a larger sample.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Overall Survival, Tumor Burden, Thoracoscopy, CT Scan, Hemithorax, Hazard Ratio.

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• The effect of clinical covariates on the diagnostic and prognostic value of soluble mesothelin and megakaryocyte potentiating factor — K. Hollevoet, K. Nackaerts, et al. (2012)
• Diagnostic and prognostic value of soluble syndecan-1 in pleural malignancies — F. Mundt, G. Heidari-Hamedani, et al. (2014)
• Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2016)
• Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2017)

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