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Multicentric study on malignant pleural mesothelioma in Turkey: clinicopathologic and survival characteristics of 282 patients

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Abstract

Malignant pleural mesothelioma (MPM) is a relatively rare, but aggressive tumor that causes high mortality. The major risk factor involved in the etiology is environmental and occupational exposure to asbestos. The optimal modality of therapy is controversial. The present study retrospectively evaluated the data pertinent to 282 patients who were examined and treated in 11 different medical oncology centers in Turkey. There were 161 males (57.1 %) and 121 females (42.9 %), with a mean age of 56.38 ± 12.07 years. Surgery was used in 74 patients, 21 patients (28.4 %) received only chemotherapy and 28 patients (37.8 %) received chemoradiotherapy after surgery. The median survival in patients who were administered adjuvant therapy after surgery was 24 months, while the median survival in patients who had only surgery was 6 months (p = 0.029). 106 patients were administered pemetrexed-platinum combination and 35 patients were administered gemcitabine-platinum combination as front-line chemotherapy. Median survival, 1- and 2-year survival rates in patients who received platinum analogues and pemetrexed or gemcitabine combinations were found statistically similar (p = 0.15). The median survival for all patients with MPM in our study was 18 months. The main factors influencing the overall survival were stage of the disease (p = 0.020), performance status (p < 0.001), asbestos exposure (p = 0.030) and mesothelioma histological subtypes (p < 0.001). Results of our study suggest that multi-modality treatment regimens consisting of surgery, radiotherapy and chemotherapy prolong overall survival. Survival rates in patients who received combining platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were found similar.

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References

  1. Price B, Ware A. Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005. Crit Rev Toxicol. 2009;39:576–88.

    Article  PubMed  Google Scholar 

  2. Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet. 2005;366:397–408.

    Article  PubMed  CAS  Google Scholar 

  3. Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT. Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases. Ultrastruct Pathol. 2002;26:55–65.

    Article  PubMed  Google Scholar 

  4. Wagner JC. Mesothelioma and mineral fibers. Cancer. 1986;57:1905–11.

    Article  PubMed  CAS  Google Scholar 

  5. Selcuk ZT, Coplu L, Emri S, Kalyoncu AF, Sahin AA, Baris YI. Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases. Chest. 1992;102:790–6.

    Article  PubMed  CAS  Google Scholar 

  6. Selcuk ZT, Emri S, Sahin AA, Baris YI, Coplu L, Kalyoncu F, et al. Malignant mesothelioma and erionite exposure. Eur Respir J. 1999;14:480–1.

    PubMed  CAS  Google Scholar 

  7. Baris YI. Fibrous zeolite (erionite)-related diseases in Turkey. Am J Ind Med. 1991;19:374–8.

    Article  PubMed  CAS  Google Scholar 

  8. Sugarbaker DJ, Norberto JJ. Multimodality management of malignant pleural mesothelioma. Chest. 1998;113:61S–5S.

    Article  PubMed  CAS  Google Scholar 

  9. Neumeister W, Gillissen A, Rasche K, Theile A, Muller KM, Schultze-Werninghaus G. Prognosis, staging and therapy of malignant pleural mesothelioma. Med Klin (Munich). 2002;97:459–71.

    Article  Google Scholar 

  10. Boutin C, Schlesser M, Frenay C, Astoul P. Malignant pleural mesothelioma. Eur Respir J. 1998;12:972–81.

    Article  PubMed  CAS  Google Scholar 

  11. Kaufman AJ, Pass HI. Current concepts in malignant pleural mesothelioma. Expert Rev Anticancer Ther. 2008;8:293–303.

    Article  PubMed  CAS  Google Scholar 

  12. Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CM, Lowry E, et al. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008;371:1685–94.

    Article  PubMed  CAS  Google Scholar 

  13. Antman K, Shemin R, Ryan L, Klegar K, Osteen R, Herman T, et al. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women’s Hospital experience over two decades, 1965–1985. J Clin Oncol. 1988;6:147–53.

    PubMed  CAS  Google Scholar 

  14. 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;113:723–31.

    Article  PubMed  CAS  Google Scholar 

  15. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest. 1995;108:1122–8.

    Article  PubMed  CAS  Google Scholar 

  16. Metintas M, Ozdemir N, Hillerdal G, Ucgun I, Metintas S, Baykul C, et al. Environmental asbestos exposure and malignant pleural mesothelioma. Respir Med. 1999;93:349–55.

    Article  PubMed  CAS  Google Scholar 

  17. Yazicioglu S. Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey. Chest. 1976;70:43–7.

    Article  PubMed  CAS  Google Scholar 

  18. Muller KM, Fischer M. Malignant pleural mesotheliomas: an environmental health risk in southeast Turkey. Respiration. 2000;67:608–9.

    Article  PubMed  CAS  Google Scholar 

  19. Senyigit A, Bayram H, Babayigit C, Topcu F, Nazaroglu H, Bilici A, et al. Malignant pleural mesothelioma caused by environmental exposure to asbestos in the Southeast of Turkey: CT findings in 117 patients. Respiration. 2000;67:615–22.

    Article  PubMed  CAS  Google Scholar 

  20. Barıs YI, Artvinli M, Sahin AA. Environmental mesothelioma in Turkey. Ann NY Acad Sci. 1980;330:423–32.

    Article  Google Scholar 

  21. Metintas M, Hillerdal G, Metintas S. Malignant mesothelioma due to environmental exposure to erionite: follow-up of a Turkish emigrant cohort. Eur Respir J. 1999;13:523–6.

    Article  PubMed  CAS  Google Scholar 

  22. Dumortier P, Gocmen A, Laurent K, Manco A, De Vuyst P. The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease. Eur Respir J. 2001;17:922–7.

    Article  PubMed  CAS  Google Scholar 

  23. Baris I, Simonato L, Artvinli M, Pooley F, Saracci R, Skidmore J, et al. Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four-year study in the Cappadocian region of Turkey. Int J Cancer. 1987;39:10–7.

    Article  PubMed  CAS  Google Scholar 

  24. Emri S, Demir A, Doğan M. Lung diseases due to environmental exposures to erionite and asbestos in Turkey. Toxicol Lett. 2002;127:251–7.

    Article  PubMed  CAS  Google Scholar 

  25. Artvinli M, Baris YI. Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study. Arch Environ Health. 1982;37:177–81.

    PubMed  CAS  Google Scholar 

  26. Sakellariou K, Malamou-Mitsi V, Haritou A, Koumpaniou C, Stachouli C, Dimoliatis ID, et al. Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? Eur Respir J. 1996;9:1206–10.

    Article  PubMed  CAS  Google Scholar 

  27. Bianchi C, Giarelli L, Grandi G, Brollo A, Ramani L, Zuch C. Latency periods in asbestos-related mesothelioma of the pleura. Eur J Cancer Prev. 1997;6:162–6.

    PubMed  CAS  Google Scholar 

  28. Baris YI, Bilir N, Artvinli M, Sahin AA, Kalyoncu F, Sebastien P. An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos. Br J Ind Med. 1988;45:838–40.

    PubMed  CAS  Google Scholar 

  29. Metintas S, Metintas M, Ucgun I, Oner U. Malignant mesothelioma due to environmental exposure to asbestos: follow-up of a Turkish cohort living in a rural area. Chest. 2002;122:2224–9.

    Article  PubMed  Google Scholar 

  30. Senyigit A, Babayigit C, Gokirmak M, Topcu F, Asan E, Coskunsel M, et al. Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. Respiration. 2000;67:610–4.

    Article  PubMed  CAS  Google Scholar 

  31. Schwartz DA. New developments in asbestos-induced pleural disease. Chest. 1991;99:191–8.

    Article  PubMed  CAS  Google Scholar 

  32. Brenner J, Sordillo PP, Magill GB, Golbey RB. Malignant mesothelioma of the pleura: review of 123 patients. Cancer. 1982;49:2431–5.

    Article  PubMed  CAS  Google Scholar 

  33. 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;72:394–404.

    Article  PubMed  CAS  Google Scholar 

  34. Kurt B, Gülhan M, Apaydın Z, Ark D. Malignant pleural mesothelioma: a retrospective analysis of 57 cases. ERJ 1997;(Suppl 25):199.

  35. Yates DH, Corrin B, Stidolph PN, Browne K. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. 1997;52:507–12.

    Article  PubMed  CAS  Google Scholar 

  36. Pisani RJ, Colby TV, Williams DE. Malignant mesothelioma of the pleura. Mayo Clin Proc. 1988;63:1234–44.

    PubMed  CAS  Google Scholar 

  37. Sovak MA, Aisner SC, Aisner J. Tumors of the pleura and mediastinum. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, editors. Abeloff’s clinical oncology, vol. 4. Philadelphia: Churchill Livingstone; 2008. p. 1367–90.

    Chapter  Google Scholar 

  38. Hillerdal G. Malignant mesothelioma 1982: review of 4710 published cases. Br J Dis Chest. 1983;77:321–43.

    Article  PubMed  CAS  Google Scholar 

  39. Cugell DW, Kamp DW. Asbestos and the pleura: a review. Chest. 2004;125:1103–17.

    Article  PubMed  Google Scholar 

  40. Renshaw AA, Dean BR, Antman KH, Sugarbaker DJ, Cibas ES. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest. 1997;111:106–9.

    Article  PubMed  CAS  Google Scholar 

  41. Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc. 1985;60:158–64.

    PubMed  CAS  Google Scholar 

  42. Herbert A, Gallagher PJ. Pleural biopsy in the diagnosis of malignant mesothelioma. Thorax. 1982;37:816–21.

    Article  PubMed  CAS  Google Scholar 

  43. Whitaker D, Shilkin KB. Diagnosis of pleural malignant mesothelioma in life–a practical approach. J Pathol. 1984;143:147–75.

    Article  PubMed  CAS  Google Scholar 

  44. Pistolesi M, Rusthoven J. Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies. Chest. 2004;126:1318–29.

    Article  PubMed  Google Scholar 

  45. Adams VI, Unni KK, Muhm JR, Jett JR, Ilstrup DM, Bernatz PE. Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases. Cancer. 1986;58:1540–51.

    Article  PubMed  CAS  Google Scholar 

  46. Segal A, Whitaker D, Henderson D, Shilkin K. Pathology of mesothelioma. In: Robinson BWS, Chahinian AP, editors. Mesothelioma. London: Martin Dunitz; 2002. p. 143–84.

    Google Scholar 

  47. Tammilehto L, Maasilta P, Kostiainen S, Appelqvist P, Holsti LR, Mattson K. Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients. Respiration. 1992;59:129–35.

    Article  PubMed  CAS  Google Scholar 

  48. Butchart EG. Contemporary management of malignant pleural mesothelioma. Oncologist. 1999;4:488–500.

    PubMed  CAS  Google Scholar 

  49. Sugarbaker DJ, Jaklitsch MT, Liptay MJ. Mesothelioma and radical multimodality therapy: who benefits? Chest. 1995;107:345S–50S.

    Article  PubMed  CAS  Google Scholar 

  50. Tsiouris A, Walesby RK. Malignant pleural mesothelioma: current concepts in treatment. Nat Clin Pract Oncol. 2007;4:344–52.

    Article  PubMed  Google Scholar 

  51. Buduhan G, Menon S, Aye R, Louie B, Mehta V, Vallieres E. Trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2009;88:870–5. (discussion 6).

    Article  PubMed  Google Scholar 

  52. Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999;117:54–63. (discussion 5).

    Article  PubMed  CAS  Google Scholar 

  53. Lucchi M, Chella A, Melfi F, Dini P, Ambrogi M, Fino L, et al. A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2007;31:529–33. (discussion 33–34).

    Article  PubMed  Google Scholar 

  54. Sorensen JB. Current concepts in chemotherapy for malignant pleural mesothelioma. Clin Respir J. 2008;2:74–9.

    Article  PubMed  Google Scholar 

  55. Berghmans T, Paesmans M, Lalami Y, Louviaux I, Luce S, Mascaux C, et al. Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis. Lung Cancer. 2002;38:111–21.

    Article  PubMed  CAS  Google Scholar 

  56. Ardizzoni A, Grossi F, Pennucci MC. Systemic drug therapy of malignant pleural mesothelioma. Monaldi Arch Chest Dis. 1998;53:236–40.

    PubMed  CAS  Google Scholar 

  57. Santoro A, O’Brien ME, Stahel RA, Nackaerts K, Baas P, Karthaus M, et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaive patients with malignant pleural mesothelioma: results of the International Expanded Access Program. J Thorac Oncol. 2008;3:756–63.

    Article  PubMed  Google Scholar 

  58. 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;21:2636–44.

    Article  PubMed  CAS  Google Scholar 

  59. Nowak AK, Byrne MJ, Williamson R, Ryan G, Segal A, Fielding D, et al. A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma. Br J Cancer. 2002;87:491–6.

    Article  PubMed  CAS  Google Scholar 

  60. Byrne MJ, Davidson JA, Musk AW, Dewar J, van Hazel G, Buck M, et al. Cisplatin and gemcitabine treatment for malignant mesothelioma: a phase II study. J Clin Oncol. 1999;17:25–30.

    PubMed  CAS  Google Scholar 

  61. Castagneto B, Zai S, Dongiovanni D, Muzio A, Bretti S, Numico G, et al. Cisplatin and gemcitabine in malignant pleural mesothelioma: a phase II study. Am J Clin Oncol. 2005;28:223–6.

    Article  PubMed  CAS  Google Scholar 

  62. Favaretto AG, Aversa SM, Paccagnella A, Manzini VP, Palmisano V, Oniga F, et al. Gemcitabine combined with carboplatin in patients with malignant pleural mesothelioma: a multicentric phase II study. Cancer. 2003;97:2791–7.

    Article  PubMed  CAS  Google Scholar 

  63. Lee C, Murray N, Anderson H, Bouttell E. Outcomes with platinum plus gemcitabine or pemetrexed as first-line systemic therapy for malignant pleural mesothelioma in British Columbia: a review of province-wide practice. J Thorac Oncol. 2007;2:606.

    Article  Google Scholar 

  64. Metintas M, Metintas S, Ucgun I, Gibbs AR, Harmanci E, Alatas F, et al. Prognostic factors in diffuse malignant pleural mesothelioma: effects of pretreatment clinical and laboratory characteristics. Respir Med. 2001;95:829–35.

    Article  PubMed  CAS  Google Scholar 

  65. Curran D, Sahmoud T, Therasse P, van Meerbeeck J, Postmus PE, Giaccone G. Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience. J Clin Oncol. 1998;16:145–52.

    PubMed  CAS  Google Scholar 

  66. Borasio P, Berruti A, Bille A, Lausi P, Levra MG, Giardino R, et al. Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients. Eur J Cardiothorac Surg. 2008;33:307–13.

    Article  PubMed  Google Scholar 

  67. Chailleux E, Dabouis G, Pioche D, de Lajartre M, de Lajartre AY, Rembeaux A, et al. Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest. 1988;93:159–62.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Oncology, Faculty of Medicine, Inonu University, Malatya, Turkey

    Emin Tamer Elkiran & Hakan Harputluoglu

  2. Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey

    Mehmet Ali Kaplan & Abdurrahman Isikdogan

  3. Department of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey

    Alper Sevinc

  4. Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey

    Sercan Aksoy & Nuriye Yildirim Ozdemir

  5. Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey

    Umut Demirci & Suleyman Buyukberber

  6. Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey

    Mesut Seker

  7. Departments of Thoracic Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey

    Feridun Isik

  8. Department of 1st Medical Oncology, Ankara Oncology Research and Training Hospital, Ankara, Turkey

    Arife Ulas

  9. Department of Medical Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Mevlude Inanc

  10. Department of 2nd Medical Oncology, Ankara Oncology Training and Research Hospital, Ankara, Turkey

    Ulku Yalcintas Arslan

  11. Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey

    Gamze Gokoz Dogu

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  1. Emin Tamer Elkiran
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Elkiran, E.T., Kaplan, M.A., Sevinc, A. et al. Multicentric study on malignant pleural mesothelioma in Turkey: clinicopathologic and survival characteristics of 282 patients. Med Oncol 29, 3147–3154 (2012). https://doi.org/10.1007/s12032-012-0276-y

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