Survival of malignant pleural mesothelioma cases in the Tuscan Mesothelioma Register, 1988-2000: a population-based study

Our plain-English summary of Survival of malignant pleural mesothelioma cases in the Tuscan Mesothelioma Register, 1988-2000: a population-based study, by G. Gorini, G. De Gregorio, S. Silvestri, et al (European Journal of Cancer Prevention, 2005).

The study

• Authors: G. Gorini, G. De Gregorio, S. Silvestri, E. Chellini, V. Cupelli, A. Seniori Costantini
• Journal: European Journal of Cancer Prevention
• Published: 2005;14(3):195-9
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study analyses survival of Tuscan residents (Italy, 3.5 million population) diagnosed by histological examination with malignant pleural mesothelioma (MPM) during the period 1988-2000, and recorded in the Tuscan Malignant Mesothelioma Register. The aim was to establish the prognostic role of demographic, diagnostic and asbestos exposure variables. During 1988-2000, 381 MPM cases were recorded (318 men; 63 women). Vital status was ascertained up to 31 December 2002. No cases were lost to follow-up. Median survival of certain MPM was 324 days (11 months; 95% CI 297-366); 45.7% (95% CI 40.6-50.6%) survived more than 1 year; 24.2% (95% CI 20.0-28.5%) more than 2 years. In univariate and multivariate analyses survival was associated with histological subtype (epithelioid subtype had the longest survival). Gender, age, period of diagnosis, hospital of diagnosis and asbestos exposure did not show significant effects. Therapeutic information was available for patients of the period 1997-2000. There was no significant difference in survival between treated versus untreated patients. In conclusion, no advance in prognosis at the population level in the most recent period can be suggested on the basis of the data available to the Tuscan Malignant Mesothelioma Register.

In plain English

This population-based study followed 381 Tuscan residents (318 men, 63 women) with histologically confirmed malignant pleural mesothelioma, diagnosed 1988 to 2000 and recorded in the regional register, up to 31 December 2002. Median survival was 324 days (95% CI 297 to 366). 45.7% (95% CI 40.6 to 50.6%) survived more than 1 year and 24.2% (95% CI 20.0 to 28.5%) more than 2 years. In a combined analysis, cases with unspecified morphology had higher risk than epithelioid cases (hazard ratio 1.45, 95% CI 1.06 to 1.99). In that analysis, gender, age, period of diagnosis, hospital of diagnosis and asbestos exposure showed no significant effects. Hospital of diagnosis was significant only in the unadjusted analysis (P 0.016). Among 1997 to 2000 cases, those given surgery, radiation or chemotherapy survived longer (median 438 days, 95% CI 376 to 621) than those with nonspecific or unknown treatment (median 198 days, 95% CI 134 to 260). After adjustment, the difference was not significant (hazard ratio 0.73, 95% CI 0.49 to 1.08). The authors noted missing data on disease stage, treatment and quality of life. They concluded the data did not suggest an advance in population-level prognosis.

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 of cancer register cases, using Kaplan-Meier survival estimates, log-rank tests and multivariate Cox proportional hazards regression
• Who was studied: 381 Tuscan residents (318 men, 63 women) with malignant pleural mesothelioma confirmed by histological examination ('certain' cases), diagnosed 1988 to 2000. Vital status was followed to 31 December 2002. A further 119 'suspected' cases were not included in the survival analysis, and neither were cases diagnosed only at autopsy.
• Exposure: An industrial hygienist classified asbestos exposure from questionnaire interviews. Cases were grouped as certain and probable occupational exposure (212 cases, 55.6%) versus possible occupational, household, environmental, unknown or unlikely exposure (169 cases, 44.4%). No fiber types are reported.
• Main results:
  • Among all 381 certain cases, median survival was 324 days (11 months; 95% CI 297–366). 45.7% (95% CI 40.6–50.6%) survived more than 1 year, and 24.2% (95% CI 20.0–28.5%) survived more than 2 years.
  • In univariate analysis, survival was associated with type of hospital of diagnosis and with histological subtype.
  • In univariate analysis (Table 2), the log-rank P value for hospital of diagnosis was 0.016. Cases diagnosed in hospitals with thoracic surgery had a median survival of 361 days, and cases diagnosed in hospitals without thoracic surgery had a median of 285 days.
  • The 187 epithelioid subtype cases had a median survival of 415 days (95% CI 326–498), the longest of the subtypes in Table 2.
  • In the multivariate model, cases with unspecified morphology had a higher risk than epithelioid cases (HR 1.45; 95% CI 1.06–1.99).
  • In the multivariate model, fibrous and mixed subtypes showed a higher risk than epithelioid, but the difference was not statistically significant.
  • In the multivariate model, gender, age, period of diagnosis, hospital of diagnosis and asbestos exposure did not show significant effects. The possible/household/environmental/unknown/unlikely exposure group had an HR of 1.01 (95% CI 0.79–1.28) compared with certain and probable occupational exposure.
  • In univariate analysis of 1997–2000 cases, patients treated with surgery, radiation or chemotherapy had a median survival of 438 days (95% CI 376–621). The comparison group was patients with nonspecific ('aspecific') or unknown treatment.
  • Among 1997–2000 cases, the group with nonspecific or unknown treatment (labelled 'untreated cases') had a median survival of 198 days (95% CI 134–260). The log-rank P value for the comparison with treated cases was 0.002.
  • Among 1997–2000 cases, the Cox model adjusted for sex, age, histology subtype and type of hospital found no significant difference between treated and untreated cases (HR 0.73; 95% CI 0.49–1.08).
• The authors' conclusion: The authors concluded that, on the basis of the data currently available to the Tuscan register, no advance in prognosis at the population level can be suggested.
• Limitations the authors state:
  • The authors state that the main limit is the lack of information on disease stage at diagnosis, treatment and patients' quality of life.
  • Treatment data were found for only 221 of 381 cases (58.0%), most of them from 1997–2000.
  • The authors attribute the longer univariate survival in hospitals with thoracic surgery mainly to selection bias, because patients in better condition were more likely to go to specialized hospitals.
  • The authors attribute the improvement in survival in the last period of diagnosis probably to lead time bias (earlier 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: Pleural Mesothelioma, Mesothelioma, Asbestos Exposure, Median Overall Survival, Histological Subtype, Epithelioid, Prognosis.

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