Thromboembolic Events in Malignant Pleural Mesothelioma

Our plain-English summary of Thromboembolic Events in Malignant Pleural Mesothelioma, by D. Koksal, O. Safak, A. Ozcan, et al (Clinical and Applied Thrombosis/hemostasis, 2016).

The study

• Authors: D. Koksal, O. Safak, A. Ozcan, Y. Agackiran, H. Erturk, G. Findik
• Journal: Clinical and Applied Thrombosis/hemostasis
• Published: 2016;22(4):390-4
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: Malignant pleural mesothelioma (MPM) increases the risk of thromboembolic events (TEEs). In this retrospective study, we aimed to determine the rate of TEEs in MPM and investigate its relationship with the presence of thrombocytosis, the disease stage, and the tumor histopathology.

Methods: The study included 178 patients who were histopathologically diagnosed as MPM between the years January 2008 and June 2014.

Results: The mean age was 58.7 ± 11.8 years, and the median follow-up time was 8 months. Seventy-one patients (39.9%) had thrombocytosis (>350 × 10(3)/mL). In total, 14 (7.9%) TEEs were identified: 6 (3.4%) pulmonary thromboembolism, 6 (3.4%) deep venous thrombosis, and 2 (1.1%) myocardial infarctions. Although 5 (2.8%) of the TEEs preceded the diagnosis of MPM, 1 (0.6%) occurred simultaneously with the diagnosis of MPM and 8 (4.5%) followed the diagnosis of MPM. Thromboembolic event rates were not statistically different based on the presence of thrombocytosis (P = .51), disease stage (P = .14), and histopathology (P = .38).

Conclusion: The rate of TEEs was 7.9%. Presence of thrombocytosis, disease stage, and histopathology did not affect the incidence of TEEs.

© The Author(s) 2014.

In plain English

This retrospective study reviewed records of 178 patients diagnosed with malignant pleural mesothelioma from January 2008 to June 2014 at a hospital in Ankara, Turkey. It counted thromboembolic events (blood clots and heart attacks) and tested links with thrombocytosis (a high platelet count), disease stage and tumor type. Most patients (74.8%) had a history of asbestos exposure, mostly environmental. Median follow-up was 8 months. In total, 14 events (7.9%) were recorded: 6 pulmonary embolisms, 6 deep venous thromboses and 2 myocardial infarctions. Five came before the mesothelioma diagnosis, 1 at the same time and 8 after it. The event rate was 8.5% in the 71 patients with thrombocytosis and 7.5% in the 107 without (P = .51). Differences by stage (P = .14) and tumor type (P = .38) were not statistically significant. The authors concluded that the 7.9% rate showed a high incidence of these events in mesothelioma. They also concluded that thrombocytosis, stage and tumor type did not affect it. They noted that the study was retrospective, that follow-up was short, and that clots without symptoms may have been missed.

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 study of hospital patient files (single-center case series)
• Who was studied: 178 patients (106 males, 72 females; mean age 58.7 years) histopathologically diagnosed with malignant pleural mesothelioma between January 1, 2008 and June 30, 2014 at a chest diseases and chest surgery hospital in Ankara, Turkey
• Exposure: The study examined thromboembolic events in malignant pleural mesothelioma in relation to thrombocytosis (platelet count above 350 × 10^3/mL), disease stage and histopathology. Asbestos exposure history was recorded as background only: environmental in 129 (72.5%), occupational in 3 (1.7%), both in 1 (0.6%), none in 45 (25.2%). No fiber types were named.
• Main results:
  • Among all 178 patients, 14 (7.9%) thromboembolic events were recorded, counting events before, at the time of, and after the mesothelioma diagnosis: 6 (3.4%) pulmonary thromboembolism, 6 (3.4%) deep venous thrombosis (4 lower and 2 upper extremity), and 2 (1.1%) myocardial infarctions. Separately, the median follow-up time was 8 months.
  • Of the 14 events, 8 (57.1%) occurred after the mesothelioma diagnosis (median 2.5 months), 5 (35.7%) occurred before it (median 10 months, range 1 to 48), and 1 (7.2%) occurred at the same time. All events before the diagnosis were unprovoked.
  • 71 patients (39.9%) had thrombocytosis. Event rates did not differ significantly: 6 of 71 (8.5%) with thrombocytosis versus 8 of 107 (7.5%) without (P = .51).
  • More events occurred in advanced stages (9 of the 14 events, 64.3%), but the difference by stage was not statistically significant (P = .14).
  • Event rates by histopathology were not significantly different (P = .38): epithelial 7 of 97 (7.2%), biphasic 1 of 31 (3.2%), sarcomatous 0 of 4, unidentified 6 of 46 (13%).
• The authors' conclusion: The authors concluded that the rate of thromboembolic events was 7.9%, which in their view demonstrated a high incidence in patients with malignant pleural mesothelioma. They also concluded that thrombocytosis, disease stage and histopathology did not affect that incidence.
• Limitations the authors state:
  • Retrospective design and slightly short follow-up (median 8 months)
  • Asymptomatic events may have been missed, because CT angiography or venous Doppler ultrasound was performed only for patients with symptoms
  • Information on therapies other than the chemotherapy protocols, and on the use of anticoagulant prophylaxis, was not available
  • Staging problems in mesothelioma may explain the lack of a stage difference, since patients were staged mostly on clinical and radiological findings
  • Histology was unidentified in a high share of patients (25.8%), probably because of smaller biopsy techniques

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: Pleural Mesothelioma, Histopathology.

Related studies

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• Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy — Y.C. Li, T. Khashab, et al. (2017)
• Pretreatment thrombocytosis as a significant prognostic factor in malignant mesothelioma: a meta-analysis — Y. Zhuo, L. Lin, et al. (2017)
• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis — F. Sato, H. Yamazaki, et al. (2000)
• Commentary: Focused attention on proactive identification of deep venous thrombosis after pleurectomy/decortication for malignant pleural mesothelioma — S.S. Groth, R.T. Ripley, et al. (2020)
• Causal attribution and life-threatening disease — C. Mumma, R. McCorkle (1982)

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