The diagnosis, therapy and prognosis of diffuse malignant mesothelioma

Abstract

Between 1969 and 1985, 245 patients with diffuse malignant mesothelioma were treated (157 male, 88 female). The average age was 55.8 years and the sex ratio was 1.8:1 in favour of males. The right side was more frequently affected than the left (56.7% vs. 43.3%). A pleural effusion and dyspnoea were the presenting signs and symptoms in 83.7% of the patients and unilateral chest pain in 64.2%. Noninvasive diagnostic procedures included a chest X-ray and computed tomography of the thorax. Pleural effusion and pleural thickening were detected most frequently. Malignant cells were identified by pleural fluid cytology in 45.3% and by needle biopsy of the pleura in 42.7% of the patients. Forty-five patients were treated conservatively and 200 patients underwent operation: diagnostic thoracotomy (78); partial pleurectomy (72); total pleurectomy (46); extended pleuropneumonectomy (2); partial removal of the diaphragm (1) and total pleurectomy and upper lobectomy (1). The perioperative mortality was 6%. The conservative and postoperative treatment depended on the patients' symptoms and included radiotherapy and chemotherapy alone or in combination. The mean survival time of the 222 non-survivors was 9.2 months. After 1 year, 36% of the patients were still alive, after 2 years, 10.8% and the 5-year survival was 4.1%. The median survival time in patients treated non-operatively was 6 months--a little over half that of the patients treated surgically (10.1 months).

Diagnosis and Prognostic Factors in Malignant Pleural Mesothelioma: A Retrospective Analysis of Sixty-Five Patients

“…Males were affected more frequently than females, in the ratio 2:1, which matches other reports [11], The average age of our patients was younger (mean age 54 years) than the 56-59 years recorded in the literature (11,12]. This could reflect the referral pattern between 1960 and 1980, when only patients who were potential candidates for treatment were referred to the University Central Hospi tal.…”

A systematic review of lung-sparing extirpative surgery for pleural mesothelioma

“…21 In some, particularly more recent series, PD is performed with radical intent. 8 We judge that resection of the diaphragm or pericardium was infrequently performed in early series because it is specifically mentioned if done 16,31,32 whereas it is included in the general operative description in more recent reports. 5,8,11,13 It appears that it was optional with a degree of selection for appropriateness but it is often unclear in how many patients these steps were taken ( Table 2).…”

“…In seven reports 8,20,21,24,25,31,32 there is a breakdown by stage of operated patients ( Table 1). The staging systems have varied over time and are more comprehensively reported in some recent papers, for example in 2008 by Nakas.…”

“…Asbestos exposure was recorded in 13 papers 7,8,13,16,17,21,22,24,25,27,[31][32][33] and was positive in 64% of patients (682/1061 patients) with a range of 17-95%. The rate in some reports is given for all mesothelioma patients, not just those operated.…”

“…In the non-operative group, the 5-year survival was 11.4% (5 of 44 patients) whereas in the operative group, the comparable figure was 2.2% (4 of 178 patients)' and yet they concluded 'Decortication and pleurectomy, when possible, is the treatment of choice'. 32 Since lung-sparing surgery is being promoted as a clinical option for MPM patients in the modern era, knowledge of these results should be available to inform patients. If we are to move the emphasis from making an impact on survival to improving the quality of that survival, then more information is required concerning patient reported outcomes, their ability to breathe, and their quality of life.…”