Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma

Our plain-English summary of Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma, by G.L. Ceresoli, L.D. Locati, A.J. Ferreri, et al (Lung Cancer, 2001).

The study

• Authors: G.L. Ceresoli, L.D. Locati, A.J. Ferreri, C. Cozzarini, P. Passoni, G. Melloni, P. Zannini, A. Bolognesi, E. Villa
• Journal: Lung Cancer
• Published: 2001;34(2):279-87
• Cited by: 92 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

One-hundred and twenty-one cases of malignant pleural mesothelioma (MPM) seen between 1986 and 1999 at the authors' Institution were reviewed. Histotype was epithelial in 88 patients (73%), sarcomatous in 21 (17%) and mixed in 12 (10%). Ninety-one patients received a treatment (38 palliative pleurectomy and no further therapy, 16 palliative pleurectomy followed by chemotherapy, 37 chemotherapy alone), while 30 were referred to supportive care only. Median survival of the whole population was 10.5 months. The 1-, 2- and 3-year survival were 40, 17 and 8%, respectively. Univariate analysis of subgroups showed that poor performance status (PS), non-epithelial histotype, Butchart stage>I and International Mesothelioma Interest Group (IMIG) stage>I were individually associated with lower survival. Patients receiving any therapy survived longer than patients treated with supportive care only (P=0.0004). Treatment modality had an independent prognostic value (P=0.00005), with a survival advantage for patients receiving surgery and adjuvant chemotherapy. Multivariate analysis confirmed the independent prognostic value of PS (P=0.001; HR=2.48) and treatment modality (P=0.003; HR=1.38). The prognostic role of PS (P=0.02) and treatment modality (P=0.01) was confirmed in the subset of patients with epithelial histology. On the contrary, therapy had no impact on survival in patients with sarcomatoid MPM (P=0.74). Despite the predicted bias of a retrospective non-randomized evaluation of treatment-related factors, patients with good PS and epithelial histology seemed to have a survival benefit from surgery or multimodality therapy, as opposite to patients with poor PS or non-epithelial histotype. However, these results must be confirmed in a larger prospective trial with uniform treatment.

In plain English

This retrospective study reviewed 121 patients with malignant pleural mesothelioma seen at a hospital in Milan, Italy, between August 1986 and October 1999. Tumors were epithelial in 88 patients, sarcomatous in 21 and mixed in 12. Of the 77 patients with asbestos exposure information, 53 were classified as certainly or probably exposed. Median survival for the whole group was 10.5 months. Patients given any treatment (surgery, chemotherapy, or both) had a median survival of 12 months, compared with 4 months for those given supportive care only. In the adjusted analysis, performance status (how well a patient functions day to day) and treatment type were each independently associated with survival. Stage and tumor type were not. Among epithelial tumors, median survival was 18 months with surgery plus chemotherapy and 4 months with supportive care. Among the 21 sarcomatoid tumors, treatment showed no impact on survival. The authors cautioned that this non-randomized study may reflect selection bias and that no definitive conclusion about treatment can be drawn.

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 review of a single institution's series of patients, analysing survival according to prognostic factors and treatment
• Who was studied: 121 patients with histologically confirmed malignant pleural mesothelioma referred to San Raffaele H Scientific Institute, Milan, Italy, between August 1986 and October 1999; 88 epithelial, 21 sarcomatous, 12 mixed
• Exposure: The study's focus was treatment (palliative pleurectomy, chemotherapy, both, or supportive care), not asbestos. Asbestos exposure, judged from occupational history, was known for 77 patients, and 53 (69%) of them were classified as certainly or probably exposed. No fiber types were named.
• Main results:
  • Histologic type in the 121 patients: epithelial 88 (73%), sarcomatous 21 (17%), mixed 12 (10%)
  • Whole group: median overall survival 10.5 months (range 1 to 69); survival at 1, 2 and 3 years was 40, 17 and 8%
  • Patients receiving any treatment survived longer than patients given supportive care only: median overall survival 12 versus 4 months (P=0.0004)
  • Median survival by treatment in the whole group: surgery only 12.5 months, chemotherapy only 8 months, surgery plus chemotherapy 14 months
  • Multivariate analysis of the whole group: performance status (P=0.001; HR=2.48, 95% CI 1.44 to 4.27) and treatment modality (P=0.003; HR=1.38, 95% CI 1.12 to 1.70) had independent prognostic value
  • In the multivariate analysis, Butchart stage (P=0.95), IMIG stage (P=0.15) and histology (P=0.21) had no prognostic value
  • Epithelial mesothelioma: median overall survival was 18, 14, 8 and 4 months for combined treatment, surgery, chemotherapy and supportive care; 1-year survival was 71, 56, 39 and 26%
  • Sarcomatoid mesothelioma (21 patients): therapy had no impact on survival (P=0.74)
  • Sarcomatoid mesothelioma: median survival was 7 months after surgery, 6 months after chemotherapy and 4 months with supportive care
• The authors' conclusion: The authors concluded that performance status was the main prognostic factor. They also concluded that type of therapy seemed to have a prognostic role in epithelial tumors but no impact in sarcomatoid tumors, and that only prospective trials can establish a standard of care.
• Limitations the authors state:
  • The evaluation of treatment was retrospective, so the patient groups may be affected by selection bias, and different therapeutic protocols were used
  • The sarcomatoid group was small
  • No definitive conclusion about treatment can be drawn from the subset analysis
  • IMIG staging was assigned retrospectively to 63 patients diagnosed before 1996 and was applied to non-surgical patients, a system the authors describe as difficult to apply without surgery

Topics

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

Medical terms in this study, explained in our Lexicon: Histological Subtype, Pleural Mesothelioma, Palliative Care, Chemotherapy, Median Survival, Performance Status, Mesothelioma, IMIG.

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