The clinicopathological characteristics with long-term outcomes in malignant mesothelioma

Our plain-English summary of The clinicopathological characteristics with long-term outcomes in malignant mesothelioma, by M. Dogan, G. Utkan, C. Hocazade, et al (Medical Oncology, 2014).

The study

• Authors: M. Dogan, G. Utkan, C. Hocazade, D. Uncu, S. Toptas, N. Ozdemir, N. Zengin, F. Icli
• Journal: Medical Oncology
• Published: 2014;31(10):232
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is a neoplasm which originates from serous membranes. It is relatively more common in Turkey. Ninety-nine patients between 2002-2009 were evaluated for survival and patient characteristics with chest pain, dyspnea, weight loss, loss of appetite, anemia, leukocytosis, thrombocytosis and lactate dehydrogenase (LDH) elevation, retrospectively. Male/female ratio was 1.41(58/41). Median age was 53(27-88). Asbestosis exposure rate was 78.5%. Most of the patients had better ECOG-PS (88.7% for 1-2). Chest pain (47.7%), dyspnea (44.8%), weight loss (49%), loss of appetite (50%), anemia (38%), leukocytosis (37.2%), thrombocytosis (26.6%) and LDH elevation (10.1%) were found with median values such as 11.8 g/dL (5-17.1) for hemoglobin, 8,800/mm3 for WBC (2,600-38,300), 382,000/mm(3) for platelets (28,000-1,504,000) and 253 IU/L for LDH (85-1,877), respectively. The most common site was pleura (62.3%). Half of the patients were unclassified, while epitheloid histopathology (39.4%) was most common in classified ones. RT rate was 42.1% in operated patients and all had pleural MM. Median OS was 22.9 months. Eighty percent of the patients had first-line CT with a clinical benefit rate of 63.3%. Second-line CT rate was 29% with a clinical benefit rate of 44%. Most preferred CT regimen was cisplatinum and pemetrexed. Most of the patients were male in their 50 s with pleural MM. They had chest pain, dyspnea, weight loss and loss of appetite as the most common symptoms at diagnosis. Only half of the patients could be subtyped with a predominance of epitheloid histology.

In plain English

This was a retrospective review of malignant mesothelioma patients followed at two Turkish centers from March 2002 to May 2009, with a literature review. The methods say 113 patients were enrolled, but the patient table describes 99 (58 men, 41 women; median age 53). The article reported that 78.5% had asbestos exposure. It did not say which asbestos fiber types were involved or how exposure was assessed. Disease was in the pleura in 62.3%, peritoneum in 31.6%, and both in 6.1%. Tissue type could not be classified in 55.6%. Epitheloid was the most common classified subtype, at 39.4% of all patients. Among 93 patients (six were lost to follow-up), median overall survival was 22.9 months (95% CI 17.3 to 28.6). Patients with performance status (ECOG-PS) of 2 or lower lived longer than those above 2 (23.6 versus 4.7 months, p = 0.007). Symptoms and blood test abnormalities did not significantly affect survival. The authors concluded that, apart from performance status, patient characteristics seemed to have no significant role in survival. They suggested the small patient number as a possible reason.

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 analysis of patients followed at two centers, with a review of the literature
• Who was studied: Patients with histologically documented malignant mesothelioma followed at two centers between March 2002 and May 2009. The authors are from medical oncology departments in Ankara, Turkey. The methods say 113 patients were enrolled. The patient table shows 58 men and 41 women (99 patients), with a median age of 53.
• Exposure: Asbestos exposure, reported as a percentage of patients (78.5%). The article gives no asbestos fiber type, source, job or dose for these patients and does not describe how exposure was assessed. The background discusses erionite, a zeolite fiber, in Turkey generally, but the results report only asbestos exposure.
• Main results:
  • The male-to-female ratio was 1.41 (58 men, 41 women). The median age was 53.
  • Tumor site: pleura 62.3%, peritoneum 31.6%, both pleura and peritoneum 6.1%.
  • Histological subtype was unclassified in 55.6% of patients. The other percentages, also of all patients, were epitheloid 39.4%, sarcomatous 2% and mixed 3%. Epitheloid was the most common subtype among those classified.
  • Median overall survival was 22.9 months (95% CI 17.3 to 28.6). It was estimated for 93 patients because six were lost to follow-up.
  • Patients with ECOG performance status of 2 or lower survived significantly longer than those with status above 2 (23.6 versus 4.7 months, p = 0.007).
  • Patients without weight loss showed a trend toward longer survival, but the difference was not statistically significant (33 versus 18 months, p = 0.211).
  • Chest pain, dyspnea, loss of appetite, anemia, leukocytosis, thrombocytosis and LDH elevation at diagnosis did not affect survival in these patients.
  • 19.8% of patients had surgery and 15.8% had radiotherapy. Patients who had an operation showed a trend toward longer survival (27.2 versus 22.6 months, p = 0.231), as did those who had radiotherapy (35.7 versus 22.6 months, p = 0.194). Neither difference was significant.
  • 80% of all patients received first-line chemotherapy. Objective response rates with first-line chemotherapy were 16.7% for cisplatinum–pemetrexed and 28.1% for cisplatinum–gemcitabine.
  • Median overall survival in the patients with pleural mesothelioma was 22.3 months.
• The authors' conclusion: The authors concluded that mesothelioma was most common in men in their fifties with pleural involvement and a high rate of asbestos exposure. They found that patient characteristics other than ECOG performance status seemed to have no significant role in survival. They said weight loss might contribute to a worse survival trend, without a statistically significant difference. They called for larger clinical trials.
• Limitations the authors state:
  • The authors suggested that the lack of a survival effect for symptoms and laboratory findings might be due to the limited number of patients in this retrospective study.
  • Pleural and peritoneal mesothelioma were analyzed together, which the authors said might have affected the results.
  • Histological subtype could not be classified in about half the patients. The authors said this was possibly because tumor tissue was inadequate when patients were referred from other centers after biopsy.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Neoplasm, Dyspnea, Lactate Dehydrogenase (LDH), Pleura, Histopathology, Pemetrexed (Alimta), Histology.

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