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

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Clinical Features in Patients With Malignant Pleural Mesothelioma With 5-Year Survival and Evaluation of Original Diagnoses.
Clinical Lung Cancer ( IF 3.3 ) Pub Date : 2020-05-23 , DOI: 10.1016/j.cllc.2020.05.020
Juuso Paajanen ₁ , Sanna Laaksonen ₂ , Ilkka Ilonen ₃ , Tapio Vehmas ₄ , Mikko I Mäyränpää ₅ , Eva Sutinen ₁ , Eeva Kettunen ₆ , Jarmo A Salo ₇ , Jari Räsänen ₇ , Henrik Wolff ₄ , Marjukka Myllärniemi ₁

Affiliation

Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.
Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland.
Occupational Safety, Finnish Institute of Occupational Health, Helsinki, Finland.
Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Introduction

Malignant pleural mesothelioma (MPM) is a fatal malignancy strongly associated with previous asbestos exposure. Overall survival remains dismal, partly owing to poor response to available treatment. The aims of this study were to evaluate diagnostic accuracy in a group of patients with MPM 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 patients with epithelial MPM. Data were collected from various national registries and electronic medical records. In addition, all available histopathologic diagnostic samples and computed tomography studies were re-evaluated by experienced specialists.

Results

Our study showed a good diagnostic accuracy, with only 1 (0.5%) patient having an incorrect MPM diagnosis. Two (0.9%) localized malignant mesotheliomas and 2 (0.9%) well-differentiated papillary mesotheliomas were also found. LTS patients were younger, more frequently female, 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.

中文翻译：

恶性胸膜间皮瘤患者 5 年生存期的临床特征和原始诊断评估。

介绍

恶性胸膜间皮瘤 (MPM) 是一种致命的恶性肿瘤，与以前的石棉接触密切相关。总生存率仍然令人沮丧，部分原因是对可用治疗的反应不佳。本研究的目的是评估一组生存时间异常长的 MPM 患者的诊断准确性，并评估与这种延长生存期相关的因素。

材料和方法

43 名总生存期超过 5 年的患者被纳入长期生存 (LTS) 组，并将这些患者与 84 名上皮性 MPM 患者进行比较。数据来自各种国家登记处和电子病历。此外，所有可用的组织病理学诊断样本和计算机断层扫描研究都由经验丰富的专家重新评估。

结果

我们的研究显示出良好的诊断准确性，只有 1 (0.5%) 名患者的 MPM 诊断不正确。还发现了两个 (0.9%) 局部恶性间皮瘤和 2 个 (0.9%) 分化良好的乳头状间皮瘤。LTS 患者更年轻，女性更常见，诊断时的体能状态更好，先前接触石棉的证据较少。在多变量分析中，我们发现肿瘤大小、东部肿瘤协作组的体能状态和一线治疗（手术和化疗）与生存时间相关。