Rare thoracic cancers, including peritoneum mesothelioma

Our plain-English summary of Rare thoracic cancers, including peritoneum mesothelioma, by S. Siesling, J.M. van der Zwan, I. Izarzugaza, et al (European Journal of Cancer, 2012).

The study

• Authors: S. Siesling, J.M. van der Zwan, I. Izarzugaza, J. Jaal, T. Treasure, R. Foschi, U. Ricardi, H. Groen, A. Tavilla, E. Ardanaz, RARECARE Working Group
• Journal: European Journal of Cancer
• Published: 2012;48(7):949-60
• Cited by: 63 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.

Copyright © 2012 Elsevier Ltd. All rights reserved.

In plain English

This European cancer registry study did not examine asbestos exposure. The authors used records of patients diagnosed from 1978 to 2002 in 89 population-based cancer registries. They described how often three rare chest cancers occurred, patient survival, and how many people lived with them. The cancers were epithelial tumours of the trachea, epithelial tumours of the thymus, and malignant mesothelioma of the pleura and pericardium or of the peritoneum and tunica vaginalis. Incidence was based on 17,688 cases. Mesothelioma was the most common (19 per million per year; 32 in men, 6.8 in women). Age-standardised mesothelioma incidence was highest in UK and Ireland (23 per million per year) and lowest in Eastern Europe (4.2). Five-year relative survival was 5% for mesothelioma overall and for mesothelioma of the pleura and pericardium, 10% for peritoneal mesothelioma, and 14% for epithelial tumours of the trachea. Mesothelioma was also the most prevalent. The authors estimated about 12,000 people living with it in the EU, by scaling registry prevalence to the 2008 EU population. The authors stated that cancer registries can help monitor the effect of regulations on asbestos use and smoking-related policies.

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: Descriptive population-based cancer registry study of incidence, survival and prevalence (RARECARE project, using EUROCARE-4 data)
• Who was studied: Cancer patients diagnosed from 1978 to 2002 in 89 population-based cancer registries in 21 European countries, with vital status known to at least 31 December 2003. The incidence analysis used 17,688 cases diagnosed 1995 to 2002 from 64 registries. The survival analysis (period 2000 to 2002) used 46 registries. The prevalence analysis used 22 registries.
• Exposure: No exposure was measured. This was a registry study of cancer occurrence and survival. Asbestos and smoking are discussed only as background and in the authors' discussion.
• Main results:
  • Mesothelioma was the most common of the rare thoracic cancers, with a crude incidence rate of 19 per million per year.
  • Mesothelioma incidence was about three times higher in men (32 per million per year) than in women (6.8 per million per year).
  • For mesothelioma of the peritoneum and tunica vaginalis, the male to female ratio was 2.
  • Among people aged 65 and older, mesothelioma had the highest incidence rate (77 per million per year).
  • Age-standardised malignant mesothelioma incidence was highest in UK and Ireland (23 per million per year) and lowest in Eastern Europe (4.2 per million per year).
  • The regional difference was driven by mesothelioma of the pleura and pericardium: 18 per million in UK and Ireland and 3.3 per million in Eastern Europe.
  • The authors estimated about 11,000 new rare thoracic cancers in Europe in 2008, of which 9500 were mesotheliomas.
  • One-year survival was about 37% both for epithelial tumours of the trachea and for mesothelioma.
  • Five-year relative survival was 5% for mesothelioma and 14% for patients with epithelial tumours of the trachea. The authors' survival comments focus on relative survival. Table 4 gives relative survival of 5.4% and 14%.
  • Patients with epithelial tumours of the thymus had the best prognosis: 85% survival at 1 year and 66% at 5 years.
  • Among mesothelioma patients, 5-year survival was 3.6% in men and 7.9% in women.
  • Among mesothelioma patients, 5-year survival was 3% in the 65 and older group and 8% in the 25 to 64 age group.
  • Five-year relative survival was 10% for mesothelioma of the peritoneum and 5% for mesothelioma of the pleura and pericardium.
  • For mesothelioma, 5-year relative survival was highest in the Eastern Europe region (12%).
  • Mesothelioma was the most prevalent of these rare cancers. The estimated number of people living with it in the EU was about 12,000 (11,841 in Table 5), followed by epithelial tumours of the thymus (7000) and trachea (1400). The authors obtained these counts by applying registry prevalence (index date 1 January 2003) to the 2008 EU population.
  • The authors revised pathology reports for samples of cases and reported that the effect of these revisions on incidence and survival rates was trivial.
• The authors' conclusion: The authors stated that cancer registries can play a role in monitoring the effect of regulations on asbestos use and smoking-related policies.
• Limitations the authors state:
  • The authors said the higher mesothelioma survival in Eastern Europe was probably influenced by the very small number of cases there.
  • The authors said another possible reason for the higher Eastern European survival was difficulty reaching a correct diagnosis, so that non-cancerous lesions were included.
  • The European burden estimates assumed that the population covered by the registries was representative of the whole EU27.
  • Mesothelioma cases with an unspecified morphology (NOS) were not included in the mesothelioma definition. The authors said these were very few (5%).
  • Many tracheal and thymic tumours could not be assigned a specific morphology. The authors said this suggests difficulties in pathological diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneum, Mesothelioma, Incidence, Prognosis, Cancer Registry.

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