Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 1;21(1):762.
doi: 10.1186/s12885-021-08532-x.

Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study

Laura Saracino  1 , Chandra Bortolotto  2 , Stefano Tomaselli  1 , Elia Fraolini  1 , Matteo Bosio  1 , Giulia Accordino  1 , Francesco Agustoni  3 , David M Abbott  4 , Emma Pozzi  3 , Dimitrios Eleftheriou  5 , Patrizia Morbini  6 , Pietro Rinaldi  7 , Cristiano Primiceri  7 , Andrea Lancia  8 , Patrizia Comoli  9 , Andrea R Filippi  8 , Giulia M Stella  10
Affiliations

Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study

Laura Saracino et al. BMC Cancer. .

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural layers. MPM has a strong association with asbestos, mainly caused by exposure to its biopersistent fibers in at least 80% of cases. Individuals with a chronic exposure to asbestos might develop disease with a 20-40-year latency with few or no symptoms. Such has been the case in the Italian regions of Piedmont and Lombardy, where industrial production of materials laden with asbestos, mainly cements, has been responsible for the onset of a large epidemic. Since 2018, a multidisciplinary team at San Matteo hospital in Pavia has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis.

Methods: Here we bring together exhaustive epidemiologic, histologic and radiologic data of 88 MPM patients that came to our observation and draw correlations with predictive and prognostic significance.

Results: The median overall survival (OS) was 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association was demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In females with no smoking history, full chemotherapeutic regimens are associated with better outcomes. Moreover, concerning second line treatments, vinorelbine emerged as the most advantageous choice for female patients, whereas in the male subgroup no statistically significant difference resulted between gemcitabine and vinorelbine.

Conclusion: A multidisciplinary approach to MPM is mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.

Keywords: Asbestos; Imaging; Mesothelioma; Multidisciplinary team.

PubMed Disclaimer

Conflict of interest statement

Authors have nothing to disclose

Figures

Fig. 1
Fig. 1
The study population. A total of 105 patients were multidisciplinarly evaluated and entered the PDTA path. We excluded from the initial study population, two only cases who were early enrolled in clinical trials in other Institutions. Based on exclusion criteria,17 patients were not included in the analysis. HL = Hodgkin lymphoma
Fig. 2
Fig. 2
Kaplan-Meier survival curves by stage. Plot of overall survival (OS) probability (Y-axis) by TNM disease stage. Time (X-axis) is expressed in months. Crosses indicate censored patients
Fig. 3
Fig. 3
Statistical and partitioning analysis of MPM patient data. Panel I. Distribution of overall survival vs TMN by gender. Distribution of OS showed no statistically significant difference if compared to TNM disease stage, except for a very slight difference related to stage IB MPM in females (A) vs males (B). Positive values show pairs of means that are significantly different. Standard deviation error bars are shown as well. Panel II. Partition analysis for overall survival of whole data. The split criterion divides the tree through a top-down clustering algorithm. Results are represented in female (C) and male (D) subgroups, respectively. Count: number of training observation; G2: Gini index. Lower values indicate better fit. Panel III. Comparison of progression free survival vs chemotherapy schedule. Distribution of PFS showed no statistically significant difference if compared to first line chemotherapy in both females (E) vs males (F). Positive values show pairs of means that are significantly different. Standard deviation error bars are shown as well. Panel IV. Comparison of overall survival vs second line chemotherapy schedule. Distribution of OS showed moderate significant difference in female patients treated with vinorelbine vs those treated with gemcitabine (G); no statistically significant differences can be shown in males (H). Positive values show pairs of means that are significantly different. Standard deviation error bars are shown as well. OS: overall survival, PFS: progression free survival, R: first line re-challenge chemotherapy, V: vinorelbine, G: gemcitabine, P: platinum. P-A: platinum-pemetrexed, NO: second line chemotherapy not performed
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pignochino Y, Dell'Aglio C, Inghilleri S, Zorzetto M, Basiricò M, Capozzi F, Canta M, Piloni D, Cemmi F, Sangiolo D, Gammaitoni L, Soster M, Marchiò S, Pozzi E, Morbini P, Luisetti M, Aglietta M, Grignani G, Stella GM. The combination of sorafenib and everolimus shows antitumor activity in preclinical models of malignant pleural mesothelioma. BMC Cancer. 2015;15(1):374. doi: 10.1186/s12885-015-1363-1. - DOI - PMC - PubMed
    1. Røe OD, Stella GM. Malignant pleural mesothelioma: history, controversy and future of a manmade epidemic. Eur Respir Rev. 2015;24(135):115–131. doi: 10.1183/09059180.00007014. - DOI - PMC - PubMed
    1. Berzenji L, Van Schil P. Multimodality treatment of malignant pleural mesothelioma. F1000Res. 2018 ;7: F1000 Faculty Rev-1681. doi: 10.12688/f1000research.15796.1. - PMC - PubMed
    1. Remon J, Passiglia F, Ahn MJ, Barlesi F, Forde PM, Garon EB, Gettinger S, Goldberg SB, Herbst RS, Horn L, Kubota K, Lu S, Mezquita L, Paz-Ares L, Popat S, Schalper KA, Skoulidis F, Reck M, Adjei AA, Scagliotti GV. Immune checkpoint inhibitors in thoracic malignancies: review of the existing evidence by an IASLC expert panel and recommendations. J Thorac Oncol. 2020;15(6):914–947. doi: 10.1016/j.jtho.2020.03.006. - DOI - PubMed
    1. Nicolini F, Bocchini M, Bronte G, Delmonte A, Guidoboni M, Crinò L, Mazza M. Malignant pleural mesothelioma: state-of-the-art on current therapies and promises for the future. Front Oncol. 2020;9:1519. doi: 10.3389/fonc.2019.01519. - DOI - PMC - PubMed

LinkOut - more resources