Survival after pleural malignant mesothelioma: a population-based study in Italy

Our plain-English summary of Survival after pleural malignant mesothelioma: a population-based study in Italy, by C. Magnani, S. Viscomi, P. Dalmasso, et al (Tumori, 2002).

The study

• Authors: C. Magnani, S. Viscomi, P. Dalmasso, C. Ivaldi, D. Mirabelli, B. Terracini
• Journal: Tumori
• Published: 2002;88(4):266-9
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: The study analyzed survival after malignant mesothelioma in the population-based Registry of Malignant Mesothelioma of Piedmont (NW Italy, 4.5 million total population). It focused on possible differences related to period of diagnosis a proxy of changes in diagnostic or therapeutic procedures.

Methods: Cases were actively searched in pathology units and files of hospital admissions and discharges. In 1990-1998, 693 incident cases were diagnosed in residents in the region: 590 of them had a histologic diagnosis of pleural mesothelioma in life and were included in the study. Vital status was ascertained at the municipality of residence as of January 1, 2000.

Results: Fifty-eight cases were alive (9.8%) and 20 were lost (3.6%) at the end of the follow-up. Median survival was 0.71 years (95% CI, 0.64-0.78). Cumulative survival was 35.9% at 1 year (95% CI, 32.0-39.8) and 14.2% at 2 years (95% CI, 11.2-17.1). Survival was associated to age (longer survival for younger subjects at diagnosis; P <0.0001) and to histology (longer survival for epithelial mesothelioma, shorter for fibrous and intermediate for mixed or unspecified types; P <0.0001). There was no difference in survival for period of diagnosis. The results were confirmed in multivariate analyses. Analyses according to type of hospital (with vs without thoracic surgery) did not show any statistically significant difference.

Discussion: The study on survival after malignant mesothelioma is the second largest of the three population-based studies in the world, which showed results similar to ours. Survival measured in published clinical series ranged between 18.4% and 57.6% at 1 year for pleural and 24.1% and 33.8% for peritoneal mesothelioma. The most striking effect of the present study was the absence of improvement in survival with period of diagnosis. Either there was no change in treatment efficacy or the effect was limited to small subgroups and could not be noticed when the analysis included larger categories.

In plain English

Using a population-based mesothelioma registry in Piedmont, Italy, the authors studied survival in 590 residents with pleural malignant mesothelioma diagnosed from tissue during life in 1990-1998. By January 1, 2000, the end of follow-up, 58 were alive and 20 lost. Median survival was 0.71 years (95% CI 0.64-0.78). Estimated cumulative survival was 35.9% at 1 year (95% CI 32.0-39.8), 14.2% at 2 years (95% CI 11.2-17.1) and 3.1% at 5 years (5 cases; 95% CI 1.1-5.0). Survival was associated with age and tissue type, but not with gender or period of diagnosis. In the multivariate analysis, patients older than 75 had a higher risk of death than the youngest age group (hazard ratio 1.73, 95% CI 1.31-2.28). So did patients with the sarcomatous type compared with the epithelial type (1.42, 95% CI 1.02-2.00). Patients first treated in hospitals specialized in thoracic diseases showed a modest, not statistically significant, survival advantage. The authors concluded that their registry's data did not allow them to postulate any recent population-level advance in prognosis. Available prognostic factors were few, the authors noted.

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: Population-based survival study using a regional mesothelioma registry (one of three such population-based survival studies, by the authors' account)
• Who was studied: 590 residents of Piedmont, Italy (total population 4.5 million), with pleural malignant mesothelioma diagnosed histologically during life in 1990-1998. Cases diagnosed only at autopsy were excluded. Vital status was ascertained as of January 1, 2000.
• Exposure: Asbestos exposure was not analysed. The study examined survival in relation to age, gender, histological type, period of diagnosis and type of hospital.
• Main results:
  • Status at the end of follow-up, all 590 cases: 58 alive (9.8%) and 20 lost to follow-up.
  • Median survival, all 590 cases: 0.71 years (95% CI 0.64-0.78), equal to 259 days or 8 months and 19 days.
  • Estimated cumulative survival (product-limit method), all cases: 35.9% at 1 year (95% CI 32.0-39.8) and 14.2% at 2 years (95% CI 11.2-17.1).
  • Estimated cumulative survival, all cases: 6.8% at 3 years (21 cases; 95% CI 4.5-9.1) and 3.1% at 5 years (5 cases; 95% CI 1.1-5.0).
  • Survival was associated with age class and histology, but not with period of diagnosis or gender.
  • Multivariate analysis: patients older than 75 had a higher risk of death than the youngest age group, the model's reference category (HR 1.73; 95% CI 1.31-2.28). The intermediate age groups had hazard ratios of 1.19 (56-65; 95% CI 0.92-1.54) and 1.12 (66-75; 95% CI 0.88-1.43).
  • Multivariate analysis: sarcomatous morphology had a higher risk of death than epithelial morphology (HR 1.42; 95% CI 1.02-2.00).
  • Multivariate analysis: period of diagnosis and gender showed no effect.
  • Cases first treated in hospitals specialized in thoracic diseases (317) were compared with cases first treated in other hospitals (273). The specialized hospitals showed only a modest difference in their favour, which was not statistically significant.
• The authors' conclusion: The authors concluded that, on the data available to their Registry, no advance in prognosis in recent years at the population level can be postulated.
• Limitations the authors state:
  • The prognostic factors available were limited to patient characteristics, such as age and gender, and to tumour characteristics.
  • Period of diagnosis was used only as a stand-in for changes in treatment.
  • Histologic diagnoses were not systematically re-reviewed for this study.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pathology, Pleural Mesothelioma, Median Survival, Histology, Mesothelioma, Thoracic Surgery, Peritoneal Mesothelioma.

Related studies

• Survival of pleural malignant mesothelioma in Italy: a population-based study — F. Montanaro, R. Rosato, et al. (2009)
• Increased risk of malignant mesothelioma of the pleura after residential or domestic exposure to asbestos: a case-control study in Casale Monferrato, Italy — C. Magnani, P. Dalmasso, et al. (2001)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)
• Survival of malignant pleural mesothelioma cases in the Tuscan Mesothelioma Register, 1988-2000: a population-based study — G. Gorini, G. De Gregorio, et al. (2005)
• Cancer mortality and incidence of mesothelioma in a cohort of wives of asbestos workers in Casale Monferrato, Italy — D. Ferrante, M. Bertolotti, et al. (2007)
• A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato, Italy — C. Magnani, B. Terracini, et al. (1993)

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