Malignant pleural mesothelioma. A clinical review of 19 patients

Our plain-English summary of Malignant pleural mesothelioma. A clinical review of 19 patients, by J. Pillgram-Larsen, L. Urdal, R. Smith-Meyer, et al (Scandinavian Journal of Thoracic and Cardiovascular Surgery, 1984).

The study

• Authors: J. Pillgram-Larsen, L. Urdal, R. Smith-Meyer, S. Birkeland
• Journal: Scandinavian Journal of Thoracic and Cardiovascular Surgery
• Published: 1984;18(1):69-73
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000566).

Abstract

A retrospective study is presented of 19 patients with pleural mesothelioma diagnosed over an 18-year period (1964-1981). Two patients are alive after observation for 12 and 16 months. In 16 fatal cases the post-diagnosis survival time was 1-113 (median 17) months. One patient was lost to follow-up after 6 months. The male: female ratio was 5.3:1. The disease was most commonly detected in persons in their sixties and seventies. Pain and dyspnoea, the most common of the presenting symptoms, occurred in half of the patients. Weight loss and malaise were reported by six patients. Mesothelioma was most common on the right side, but often spread to the left, infiltrating the pericardium and the diaphragm. Metastases to abdominal organs were found in five of the eight autopsies, and in three other patients there were clinical signs of abdominal spread. Thoracotomy was performed in 12 patients, in one of whom radical removal of the tumor was attempted, but the patient died of recurrent tumor. Radiotherapy and cytostatic medication had no demonstrable effect on survival. Pleural effusion developed in all cases and all had roentgenologically demonstrated changes. Exposure to asbestos was documented in 6 of the 19 cases. In three asymptomatic patients the mesothelioma was incidentally revealed by routine X-ray examination, and these patients had significantly longer survival than the others. One of these tumors, however, had a relatively benign histologic appearance. Frequent X-ray examination of risk groups seems to offer the only prospect of improving management by earlier diagnosis.

In plain English

This was a retrospective review of the records of 19 patients diagnosed with pleural mesothelioma at Ullevål University Hospital in Oslo, Norway, between 1964 and 1981, with follow-up until November 1982. The patients were aged 32 to 82 years (median 65), and three were women. Asbestos exposure was reliably documented in six of the 19 patients. The article does not name fiber types. Among the 16 patients who died, survival after diagnosis ranged from 1 to 113 months (median 17 months). The three patients whose tumors were found by chance on routine chest X-rays, before any symptoms, survived 30, 30 and 113 months, longer than the other patients. However, the tumor of the longest survivor looked relatively benign under the microscope, although its clinical course was malignant. In this small study, specific anti-cancer therapy was not linked to significantly longer survival, but the authors stated that the treated and untreated groups could not be assumed comparable. The authors concluded that the records could not document a relationship between mesothelioma and asbestos exposure, though the findings suggested one.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series: a review of hospital case records
• Who was studied: 19 patients diagnosed with pleural mesothelioma at the surgical or radiotherapy departments of Ullevål University Hospital, Oslo, Norway, from 1964 to 1981. They were aged 32 to 82 years (median 65), three were women, and follow-up ran until November 1982.
• Exposure: Asbestos exposure as recorded in the case records: reliably documented in six of the 19 patients and not documented in 13. No fiber types, products or jobs were reported.
• Main results:
  • Of the 19 patients, one was lost to follow-up after 6 months. The other 16 died 1 to 113 months after diagnosis, with a median survival of 17 months.
  • The three patients with no symptoms at first, whose mesothelioma was found incidentally, survived 30, 30 and 113 months. This was longer than the other patients (p between 0.01 and 0.02).
  • In the patient with the longest survival, the tumor looked benign on histologic examination. The tumor was resected but came back, aggressively invading the chest wall, and the patient died of pulmonary complications.
  • Among the patients who died, the 11 who had specific anti-cancer therapy had a median survival of 17 months (range 6 to 113). The 5 without it had a median of 7 months (range 1 to 48). The difference was not significant (p greater than 0.1).
  • The 9 patients who first presented with chest pain had a median survival of 8 months (mean 10.1). The rest of the series had a median of 28 months (mean 35.6). This difference was not significant (p between 0.05 and 0.1).
  • Spread outside the chest was found in 9 of the 19 patients.
  • The tumor started on the right side in 13 patients. Spread to the opposite pleural cavity was later found in 16 of the 19 patients.
  • Of the 12 patients who had thoracotomy (open chest surgery), radical removal of the tumor was attempted in one. That patient died of recurrent tumor after 17 months.
• The authors' conclusion: The authors concluded that, from the case records, a relationship of mesothelioma to asbestos exposure or to chronic obstructive lung disease could not be documented, although the findings suggested such relationships. They also stated that the prognosis is poor and that they knew of no treatment that prolongs survival.
• Limitations the authors state:
  • The tumors could not be staged retrospectively from the patients' records.
  • The treated and untreated groups were not randomized and could not be assumed comparable. The untreated group may have included more advanced cases.
  • Smoking history was inadequately recorded for nine patients.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Pericardium, Diaphragm, Thoracotomy, Pleural Effusion.

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