Survival from malignant mesothelioma: where are we now?

Abstract

Background: The prognosis of malignant pleural mesothelioma has traditionally been poor. Whether this remains the case compared to historical data and within a specific geographical location is uncertain. Knowledge of predictive factors for survival with malignant pleural mesothelioma is also inadequate. Methods: We conducted a retrospective local database analysis to determine overall prognosis of patients with malignant pleural mesothelioma and evaluate the influence of demographic characteristics, histological subtype and laboratory parameters. Patients with histological diagnoses of malignant pleural mesothelioma held on the NHS Grampian pathology database between 2002 and 2012 were analysed. Data on baseline demographics, mode of diagnosis, histological sub-type, and survival and serum laboratory parameters, were analysed; time to death was examined using Cox regression analyses. Results: A total of 114 patients with malignant pleural mesothelioma were included in the analysis. The median survival was 345 days (IQR 99-600). Sarcomatoid malignant pleural mesothelioma carried a significantly worse prognosis with median survival of 125 days (IQR 44-289) vs 334 days (IQR 126-715) for biphasic, 412 days (IQR 201-656) for epithelioid and 345 days (IQR 99-600) for those with no definitive typing. Individuals who did not receive chemotherapy experienced a significantly worse prognosis (hazard ratio 2.7; 95%CI 1.5-4.7; p = 0.001), while a low albumin and raised urea at time of diagnosis were also associated with a significantly poorer prognosis. Conclusion:The survival of patients with malignant pleural mesothelioma remains poor and typically around 1 year. The presence of raised urea and low albumin is associated with a poorer prognosis, while patients with a good performance status and few co-morbidities should be encouraged to receive chemotherapy.

Influence of AQP1 on cell adhesion, migration, and tumor sphere formation in malignant pleural mesothelioma is substratum- and histological-type dependent

“…MALIGNANT PLEURAL MESOTHELIOMA (MPM) is a fatal malignancy of the pleural membrane, etiologically linked to asbestos exposure, with a median survival of 12-18 mo following diagnosis (1,14). The treatment is usually palliative given the advanced stage of the disease following diagnosis; however, chemotherapy, radiotherapy, and cytoreductive surgery can be adopted with various results (2).…”

“…The treatment is usually palliative given the advanced stage of the disease following diagnosis; however, chemotherapy, radiotherapy, and cytoreductive surgery can be adopted with various results (2). Disease severity and response to treatment is among others dependent on the histological subtype of MPM, with sarcomatoid being the most aggressive and the epithelioid being the least aggressive histological subtypes (1,14). Improvement of patient care and extension of overall survival involves better diagnostic and prognostic biomarkers (19).…”

Epidemiology of Mesothelioma

“…Malignant mesothelioma (MM) is a rare tumor, rare tumors are those with incidence <6/100,000 per year (RARECARE) [25], that originates from the inner lining of the body's serous cavities (pleura, peritoneum, pericardium, and vaginal tunic of the testicle). It has a bad prognosis and is characterized by a short survival (about 12 months) [26,27]. It is considered a "sentinel event" of past exposure to asbestos in all areas where exposure to other risk factors for MM can be ruled out [28].…”

“…It is a disease characterized by a long latency interval between the onset of exposure and the appearance of the disease (from 20 to 40 years and over) [47]. The average overall survival rates (OS) range from 4 to 13 months for untreated patients and from 6 to 18 months for treated patients, only 7% of patients are still alive at five years from the diagnosis [8,27,48].…”

Puzzling Results from BAP1 Germline Mutations Analysis in a Group of Asbestos-Exposed Patients in a High-risk Area of Northeast Italy

“…Malignant mesothelioma (MM) is a highly aggressive malignancy that arises from mesothelial cells of serosal surfaces, primarily the pleura and peritoneum, and less often the pericardium or tunica vaginalis, with a median survival of 1 year from diagnosis (1). The single most important risk factor for MM is exposure to asbestos (2-4).…”