Prognostic factors in diffuse malignant pleural mesothelioma: effects of pretreatment clinical and laboratory characteristics

Background: Malignant pleural mesothelioma (MPM) has a poor prognosis. Objectives: Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM. Methods: We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients’ charts. Results: The mean age of 363 patients (217 men, 146 women) was 50.6 ± 11.2 years (range 19–85) and the mean survival time was 11.7 ± 8.6 months (range 1–53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score ≤60, a pleural fluid glucose level ≤40 mg/dl, a C-reactive protein level >50 mg/l, a serum lactate dehydrogenase level >500 U/l, the presence of pleural fluid, pleural thickening >1 cm and a platelet count of >420 × 10³/µl were found to be associated with poor prognosis in MPM. Conclusions: Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly.

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“…The mean survival time of MPM patients is 6–12 months [18,19,20,21,24,26,27], and in our study, 12 months.…”

Section: Discussionsupporting

confidence: 48%

“…In several studies, the effects of clinical and laboratory parameters on MPM prognosis have been well investigated, but the contribution of pleural fluid and radiologic features on MPM prognosis has not been studied well enough [3,8,11,18,19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma

Tanrıkulu

Abakay

Kaplan³

et al. 2010

Respiration

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“…The two most widely used scoring systems were developed by the Cancer and Leukemia Group B (CALGB) and the European Organization for Research and Treatment of Cancer (EORTC). When jointly evaluated, these studies show that pleural (as compared to peritoneal or pericardial) involvement, age older than 75 years, male gender, poor performance status, chest pain, non epithelial histology, advanced stage, leucocytosis, thrombocytosis and elevated LDH have predicted poor survival (Edwards et al, 2000;Metintas et al, 2001).…”

Section: Figure 2 Multivariate Analysis Results For Advanced Stage Smentioning

confidence: 99%

Fibulin-3 as a Diagnostic Biomarker in Patients with Malignant Mesothelioma

Kaya

Demir²,

Taylan³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: New tumour biomarkers are being intensely investigated for malignant mesothelioma (MM). Fibulin-3 is produced in MM but its role remains uncertain. The aim of this study was to evaluate the validity of measuring serum fibulin-3 in the diagnosis and prognosis of MM. Materials and Methods: This prospective study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014. Data from MM patients, including demographic and clinical features, routine laboratory data, levels of serum fibulin-3, and treatment outcomes were defined as potential prognostic factors. The receiver operating characteristic (ROC) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity. Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM. Afterwards, the possible factors identified with univariate analyses were entered into the cox regression analysis. Results: Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls. The results showed that the best cut-off point was 36.6 ng/ml with an AUC (area under the curve)=0.976, sensitivity=93.0% and specificity=90.0. In our study, the initial significant poor prognostic factors were advanced stage, high white blood cell count, high platelet count, high C-reactive protein (p<0.05 for each variable). Later, according to multivariate analysis the results showed only advanced stage as significant parameter (p=0.040). Conclusions: We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM. Also advanced stage was associated with poor MM prognosis.

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“…Bu tedavi seçeneklerine rağ-men MPM prognozu kötü bir tümördür. Yaşam süresi serilerde değişmekle birlikte (6-17 ay) ortalama süre 12 ayın altındadır (13). Ülkemizde yapılmış olan, malign mezotelyomanın klinikopatolojik özelliklerini ve sürvi özel-liklerini değerlendiren çok merkezli çalışmada tek başına cerrahi ya da kemoterapi yerine çoklu tedavi modalitelerinin sürviyi arttırdığı gösterilmiştir.…”

Section: Discussionunclassified

Malignant Pleural Mesothelioma at a Young Age

Başyiğit¹,

Boyacı²,

Uçar³

et al. 2015

Respir Case Rep

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Malign mezotelyoma asbest temasından 20-40 yıl sonra ortaya çıkan, prognozu kötü bir tümördür. Burada 27 yaşında, bilinen asbest teması olmayan bir malign plevral mezotelyoma olgusu sunulmuştur. Sigara öyküsü olmayan bayan hasta nefes darlığı ve yan ağrısı ile başvurdu. Fizik muayenede, sağ alt zonda matite tespit edilen hastanın akciğer grafisinde sağda orta zona kadar uzanan serbest plevral efüz-yon ve her iki akciğerde multipl, nodüler dansiteler saptandı. Plevral sıvı incelemesinde hemorajik karakterde eksüdatif efüzyon izlendi. Plevral sıvın ADA seviyesi, ARB ve mikobakteri kültürü negatif bulundu. Sıvı sitolojisi malignite açısından kuşkulu bulunan hastada primer odak araştırması yapıldı. Hastaya torakoskopi planlandı, pariyetal plevrada lokal tümör odakları, visseral plevrada kalınlaşma gözlendi. Biyopsi örneklerinin patoloji ve immün boyama sonuç-ları bifazik malign mezotelyoma olarak raporlandı. Sonuç olarak, malign plevral efüzyon varlığında mezotelyoma olasılığı göz ardı edilmemeli ve tanıyı kesinleştirmek için ayrıntılı immünohistokimyasal inceleme yapılmalıdır. Anahtar Sözcükler: Genç yaş, plevral efüzyon, immün boyama, podoplanin, mezotelyoma.Malignant mesothelioma is a tumor with poor prognosis that usually occurs 20-40 years after asbestos exposure. Here, we present a 27-year-old patient with malignant pleural mesothelioma who did not report any asbestos exposure. A female non-smoker was admitted with complaints of chest pain and dyspnea. The physical examination revealed dullness with percussion in the right lower lobe. There was a free-flowing pleural effusion through the right middle zone and bilaterally nodular opacities in chest x-ray. The ADA level, ARB and mycobacterium culture of the pleural fluid were negative. There were some malignant cells in the cytological examination of the fluid, and therefore the primary site of malignancy was evaluated. Thoracoscopy revealed nodular tumoral infiltration in the parietal pleura and thickness of the visceral layer. The pathological examination and immunostaining of the biopsy specimens were reported as biphasic malignant mesothelioma. In conclusion, mesothelioma should be considered in the case of malignant pleural effusion and detailed immunostaining should be performed in order to ascertain the diagnosis.

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Prognostic factors in diffuse malignant pleural mesothelioma: effects of pretreatment clinical and laboratory characteristics

Cited by 29 publications

References 28 publications

A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma

A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma

Fibulin-3 as a Diagnostic Biomarker in Patients with Malignant Mesothelioma

Malignant Pleural Mesothelioma at a Young Age

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