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Frequency, patterns and prognostic impact of distant metastases in a large mono-institutional series of malignant pleural mesothelioma (MPM): Not necessarily bad news

Date

08 Oct 2016

Session

Poster Display

Presenters

Federica Grosso

Citation

Annals of Oncology (2016) 27 (6): 522-525. 10.1093/annonc/mdw391

Authors

F. Grosso1, A. Roveta1, G. Gallizzi1, A. Muzio2, S. Zai1, F. Ugo1, A. Aurelio3, R. Libener4, M. Mancuso5, G. Ferretti6, P. Franzone7, M. Pastormerlo8, E. Piccolini9, D. Degiovanni10, G. Numico1

Author affiliations

  • 1 Oncology, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 2 Oncology, Ospedale Santo Spirito, 15033 - Casale Monferrato/IT
  • 3 Radiology, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 4 Pathological Anatomy, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 5 Thoracic Surgery, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 6 Pneumonology, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 7 Radiotherapy, AO SS Antonio e Biagio e C Arrigo, 15121 - Alessandria/IT
  • 8 Pathological Anatomy, Ospedale Santo Spirito, 15033 - Casale Monferrato/IT
  • 9 Pneumonology, Ospedale Santo Spirito, 15033 - Casale Monferrato/IT
  • 10 Palliative Care, Ospedale Santo Spirito, 15033 - Casale Monferrato/IT
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Resources

Background

MPM is a deadly cancer whose lethality is almost invariably due to thoracic loco regional progression, whereas distant metastasis (mets) are rarely reported and their prognostic impact remains unclear. The aim of this study is to describe the incidence and patterns of metastatization and to explore their potential prognostic role in a large series of MPM patients (pts) in the highly asbestos polluted area of Casale Monferrato, in the North of Italy.

Methods

Data from a dedicated MPM database were retrieved and analyzed with MedCalc Statistical Software version 16.1.

Results

From 2009/1 to 2016/1, 368 pts (118 females, 250 males), median age 70.5 (range 28 – 91, IQR 63 – 77) were treated at our institution. Pts characteristics were as follows: asbestos exposure certain professional in 147 (40%), certain domestic in 51 (14%), environmental in 170 (56%); PS 0 in 239 (75%), 1 in 95 (26%), ≥ 2 in 34 (9%); histology epithelioid in 271 (74%), biphasic in 50 (14%), sarcomatoid in 46 (12%); stage at diagnosis I – II in 147 (40%), III – IV in 221 (60%). With a median 30 months (mths) follow up, overall survival (OS) was 14.5 mths (95% CI 13.2 – 16.6). Sixty-eight pts (18%, 24 females, 44 males), 51 epithelioid, 11 biphasic and 6 sarcomatoid, had distant mets, of which 13 already had mets at diagnosis (3.5%). The other 55 patients developed mets at a median time-interval of 10 mths (95% CI 7.1 – 12.4) from diagnosis. The most common sites of mets were: lung in 26 pts (7%), peritoneum in 23 (6%), liver in 19 (5%), and bone in 16 (4%). Median OS in mets pts (n = 68) was 19 mths (95% CI 16 – 21.8). Median OS in non-distant mets pts (n = 300) was 13.4 mths (95% CI 11.7 – 15.5).

Conclusions

Eighteen % of pts in this series had distant mets, mainly in lung, liver, peritoneum and bone. Distant mets are rarely found at diagnosis (3.5%) but usually are a late event and develop at approximately two-thirds of the natural history of MPM. Acknowledging the limits of the small numbers, our results suggest that distant disease likely does not negatively affect OS compared with loco-regional progression. The longer OS of distant mets patients may indeed suggest a better controlled or a less aggressive thoracic disease.

Clinical trial identification

Legal entity responsible for the study

General Director of "SS. Antonio e Biagio e C. Arrigo" Hospital, dr Giovanna Baraldi

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.

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