Prognostic value of clinicopathological characteristic of patients with Malign Mesothelioma at Mediternean region of Turkey

Year 2022, Volume: 12 Issue: 6, 1002 - 1006, 30.11.2022

Erkan Kayıkçıoğlu , Armağan Aydın

https://doi.org/10.16899/jcm.1173730

Abstract

Aim: To define the effect of clinicopathological characteristics of patients with malign mesothelioma (MM) on overall survival.
Materials and Methods: Forty-one patients diagnosed with MM who were treated at the medical oncology clinics between 2008 to 2020 were assessed. Clinicopathological characteristics and overall survival (OS) of patients, and treatment modalities analyzed.
Results: Forty-one patients were included in this study. The median age of patients was 63.5. At a median follow-up of 16.7 (range:0.5-172.6) months, 78%(32) of patients died. Median OS was 17.6 months. 65.9% (27) of patients had stage 3 and 29.3% (12) had stage 4 diseases when they were diagnosed. Most of the patients were diagnosed at the advanced stage (Stages 3-4) (95.2%). The median OS of patients diagnosed with epithelioid histopathologic subtype was 32.4 months, while the median OS of those with sarcomatoid was 5.23 months, while the median OS of biphasic was 4.33 months. This difference was statistically significant (p<0.001). When examined in terms of treatment, there was a statistically significant difference between OSs (p=0.010). The Median OS of patients treated with chemotherapy (14.4 months) was worse than with radiotherapy-chemotherapy (42.8 months) and with surgery-chemotherapy (21.4 months). In Cox regression analysis, when sex, location, smoking, histopathological subtype, and laterality were taken together, the pathological subtype was an independent risk factor effects on survival. The sarcomatoid subtype increased death risk by 7.2 times compared to epithelioid (p=0.004), biphasic subtype increased death risk by 8.1 times compared to epithelioid (p=0.004).
Conclusion: The etiology of MM is environmental exposure to asbestos or erionite in Turkey. Epitheloid histopathology and treatment with surgery or radiotherapy in diagnosed early stages of MM can prolong the OS of patients.

Keywords

malign mesothelioma, overall survival, asbestos

Türkiye'nin Akdeniz bölgesindeki Malign Mezotelyoma hastalarının klinikopatolojik özelliklerinin prognostik değeri

Abstract

Amaç: Malign mezoteliyomalı (MM) hastaların klinikopatolojik özelliklerinin genel sağkalıma etkisini tanımlamak.
Gereç ve Yöntemler: 2008-2020 yılları arasında medikal onkoloji kliniklerinde tedavi gören MM tanılı 41 hasta değerlendirildi. Hastaların klinikopatolojik özellikleri ve genel sağkalımı (OS) ve tedavi yöntemleri analiz edildi.
Bulgular: Bu çalışmaya 41 hasta dahil edildi. Hastaların ortanca yaşı 63,5 idi. 16.7 (aralık:0.5-172.6) aylık medyan takipte hastaların %78'i (32) hayatını kaybetti. Medyan genel sağkalım 17.6 aydı. Tanı konulduğunda hastaların %65,9'u (27) evre 3 ve %29,3'ü (12) evre 4 hastalığı vardı. Hastaların çoğuna ileri evrede (Evre 3-4) (%95.2) tanı konuldu. Epiteloid histopatolojik alt tip tanısı alan hastaların medyan genel sağkalımı 32.4 ay, sarkomatoid olanların medyan genel sağkalımı 5.23 ay, bifaziklerin medyan genel sağkalımı 4.33 ay idi. Bu fark istatistiksel olarak anlamlıydı (p<0,001). Tedavi açısından bakıldığında genel sağkalımlar arasında istatistiksel olarak anlamlı fark vardı (p=0.010). Kemoterapi ile tedavi edilen hastaların genel sağkalımı 14.4 ay , radyoterapi-kemoterapi (42.8 ay) ve cerrahi-kemoterapiden (21.4 ay) olup daha kötüydü. Cox regresyon analizinde cinsiyet, lokasyon, sigara kullanımı, histopatolojik alt tip ve lateralite birlikte alındığında patolojik alt tip sağkalıma etki eden bağımsız bir risk faktörüydü. Sarkomatoid alt tipi, epiteloide göre ölüm riskini 7,2 kat (p=0,004), bifazik alt tipi ise epiteloide göre 8,1 kat artırdı (p=0,004).
Sonuç: MM etiyolojisi, Türkiye'de asbest veya erionite çevresel maruziyettir. MM'nin erken evrelerinde teşhis edilen epiteloid histopatoloji ve cerrahi veya radyoterapi ile tedavi, hastaların genel sağkalımını uzatabilir.

Keywords

Malign mesotelioma, genel sağkalım, asbestos

References

• References
• 1. Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21(14):2636-44.
• 2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.
• 3. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015;10(9):1243-60.
• 4. Aigner C, Brüning T, Eberhardt WEE, Härter M, Kaelberlah HP, Metzenmacher M, et al. [The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper]. Pneumologie. 2021;75(10):776-94.
• 5. Dogan M, Utkan G, Hocazade C, Uncu D, Toptas S, Ozdemir N, et al. The clinicopathological characteristics with long-term outcomes in malignant mesothelioma. Med Oncol. 2014;31(10):232.
• 6. Overall evaluations of carcinogenicity: an updating of IARC Monographs volumes 1 to 42. IARC Monogr Eval Carcinog Risks Hum Suppl. 1987;7:1-440.
• 7. Elkiran ET, Kaplan MA, Sevinc A, Aksoy S, Demirci U, Seker M, et al. Multicentric study on malignant pleural mesothelioma in Turkey: clinicopathologic and survival characteristics of 282 patients. Med Oncol. 2012;29(5):3147-54.
• 8. Hodgson JT, McElvenny DM, Darnton AJ, Price MJ, Peto J. The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050. Br J Cancer. 2005;92(3):587-93.
• 9. Billè A, Okiror L, Harling L, Pernazza F, Muzio A, Roveta A, et al. Analysis of survival of patients with metastatic malignant pleural mesothelioma. Tumori. 2021;107(2):110-8.
• 10. Herndon JE, Green MR, Chahinian AP, Corson JM, Suzuki Y, Vogelzang NJ. Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest. 1998;113(3):723-31.
• 11. Boutin C, Rey F, Gouvernet J, Viallat JR, Astoul P, Ledoray V. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 2: Prognosis and staging. Cancer. 1993;72(2):394-404.
• 12. Dacic S. Pleural mesothelioma classification-update and challenges. Mod Pathol. 2022;35(Suppl 1):51-6.