Certain clinical and laboratory results can help doctors predict which patients are likely to do better than others in their battle against malignant pleural mesothelioma. That’s the conclusion of a group of researches in Turkey who evaluated the medical charts of 363 malignant pleural mesothelioma patients who had been diagnosed over a span of 20 years.
Malignant pleural mesothelioma is a rare but aggressive cancer of the lining around the lungs, also called the pleura. While it is always a serious health challenge, understanding an individual patient’s prognosis can help doctors with treatment and palliative planning – without having to perform invasive procedures.
For this latest study, to be published in the peer-reviewed journal Respiration, The Turkish researchers looked at the physician notes, X-rays, CT scans and laboratory results of 217 men and 146 women diagnosed with pleural mesothelioma to see which factors seemed to have the greatest impact on survival.
All the patients evaluated for the study had been diagnosed with mesothelioma between 1989 and 2010. Most had come to their doctors complaining of shortness of breath, but many had also experienced chest pain and weight loss. Their mean age was 50.6 and their mean survival time was 11.7 months after diagnosis. Most patients (71.2%) had the epithelial type of mesothelioma, which is the most common worldwide, although 15.9% had the biphasic or ‘mixed’ type and 4.9% had sarcomatoid.
Based on all the tests that were given to these patients, the researchers found certain results that stood out as prognostic predictors. Many patients with mesothelioma experience a thickening of the pleura, or lining around the lungs, especially as the disease progresses. The traumatized pleura then produces a fluid that surrounds the lungs and this may further degrade a patient’s ability to breathe freely. The Turkish researchers found that pleural thickening greater than one centimeter and the presence of pleural fluid were associated with a poor malignant pleural mesothelioma prognosis.
In addition, laboratory analysis of that pleural fluid and blood tests also painted a grim picture for certain patients. Those who were found to have low glucose levels in their pleural fluid (less that 40 mg/dl) and high levels of C-reactive protein (higher than 50 mg/l) in their blood fared the worst long term. The new study confirms the finding of mesothelioma researchers in Tokyo who also associated high C-reactive protein levels and high white blood cell counts with higher mortality earlier this year. Although the findings may be helpful in treatment planning, the authors caution that “further prospective studies are needed to highlight prognostic factors more clearly.”
Other studies have shown that having the biphasic or sarcomatoid types of mesothelioma or being diagnosed when the cancer is in Stage III or Stage IV (an indication of its spread) are also associated with poor outcomes. A number of genetic tests are also being investigated as possible predictors of mesothelioma survival.
Tanrikulu, AC, “A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma”, September 28, 2010. Epub ahead of print. Respiration. Mineo, T “May cyclooxygenase-2 (COX-2), p21 and p27 expression affect prognosis and therapeutic strategy of patients with malignant pleural mesothelioma?” February 2010, European Journal of Cardio-Thoracic Surgery. Flores, Raja. “Positron emission tomography predicts survival in malignant pleural mesothelioma”,
June 2006, The Journal of Thoracic and Cardiovascular Surgery. 132:763-768.