Clinical Features in Patients With Malignant Pleural Mesothelioma With 5-Year Survival and Evaluation of Original Diagnoses

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a fatal malignancy strongly associated with previous asbestos exposure. Overall survival remains dismal partly due to poor response to available treatment. Aims of this study were to evaluate diagnostic accuracy in a group of MPM patients with an unusually long survival time and to assess the factors related to this prolonged survival.Materials and Methods: Forty-three patients with overall survival exceeding 5 years were accepted to the long-term survivor (LTS) group, and these patients were compared with 84 epithelial MPM patients.Data were collected from various national registers and electronic medical records. In addition, all available histopathological diagnostic samples and computed tomography studies were re-evaluated by experienced specialists.Results: Our study showed a good diagnostic accuracy, with only one patient (0.5%) having an incorrect MPM diagnosis. Two localized malignant mesotheliomas (0.9%) and two well-differentiated papillary mesotheliomas (0.9%) were also found. LTS patients were younger, more frequently females, had a better performance status at time of diagnosis, and had less evidence of prior asbestos exposure. In multivariate analysis, we showed tumor size, Eastern Cooperative Oncology Group performance status, and first-line treatment (both surgery and chemotherapy) to be associated with survival time. Conclusion:We confirmed the diagnosis of MPM in an overwhelming majority of patients in the LTS group. An epithelial subtype of MPM behaving clinically more indolently seems to exist, but further tumor and genetic characterization is needed. The prolonged survival time is most likely explained by a combination of tumor-, patient-, and treatment-related factors.

High tumor cell platelet‐derived growth factor receptor beta expression is associated with shorter survival in malignant pleural epithelioid mesothelioma

“…The study sample consisted of 74 patients from a Finnish national MPM population diagnosed during 2000–2012 [ 1 ]. From the national MPM tissue sample cohort, subgroups of long‐term MPM survivors (LTS, survival >60 months) [ 2 , 17 ], epithelioid MPM patients (EMPM, median survival 14 months) [ 2 , 17 ], extended pleurectomy MPM patients (PD), and biphasic MPM patients (BMPM) with histological samples in the Helsinki Biobank were included for constructing tissue microarrays (TMAs). The TMAs were constructed in collaboration with the Helsinki Biobank.…”

“…Detailed diagnostic information for the LTS and EMPM groups has been described previously [ 2 , 17 ]. In the PD group, samples were obtained from extended pleurectomy procedures and diagnoses were verified by HW.…”

“…We performed post hoc analyses investigating the association between high tumor cell PDGFRB expression and tumor size, mitoses, nuclear grading, and tumor architecture, as these factors have been previously shown to be associated with epithelioid MPM prognosis [ 26 , 27 , 28 ]. These factors were available for those 66 patients with epithelioid mesotheliomas who were included from our previous study [ 2 , 17 ]. We also analyzed the association of BAP1 tumor status and tumor cell PDGFRB expression.…”

The Rocky Road from Preclinical Findings to Successful Targeted Therapy in Pleural Mesothelioma

“…The incidence of PM is globally increasing, while it has remained largely unchanged in the United States in the past decades with approximately 2000 annual cases [ 2 ]. The median survival of patients with PM is 5–14 months [ 3 ], but a subset of patients experiences long-term survival [ 4 , 5 ]. PMs are divided into three histological subtypes that are the major prognostic factors: epithelioid with epithelial-shaped cells, sarcomatoid with spindle-shaped cell, and biphasic (or mixed) with a mixture of the two types of cells [ 6 ].…”

Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland

“…3 The prognosis in MPM is generally poor, 5-year survival rate ranging from 10% to 12%, 3 although substantial survival diversity has been reported, because a proportion of patients exceeds survival over 5 years. 4,5 The incidence of MPM continues to rise globally, despite asbestos usage diminishing markedly since the 1980s. 6,7 The overall financial impact of cancer on society has been of increasing interest, 8 especially MPM, which is caused mainly by occupation-related factors.…”