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Published on: December 21, 2019
Asbestos burden predicts survival in pleural mesothelioma
Brock C Christensen1, John J Godleski, Cora R Roelofs
1Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
Background:
Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of <1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors.
Objective:
The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis.
Methods:
We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women's Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n=128), and a subset of cases (n=80) with quantitative asbestos fiber burden measures.
Results:
Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p<0.04), as well as between nonepithelioid tumor histology and reduced survival (p<0.02). Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight)] into groups of low (0-99 asbestos bodies), moderate (100-1,099), and high fiber burden (>1,099), suggested a survival duration association among these groups (p=0.06). After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI), 0.95-9.5; p=0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5-15.0; p<0.01) versus those with moderate exposure.
Conclusion:
Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.
Insights
Malignant pleural mesothelioma (MPM) survival is linked to asbestos fiber burden. Higher asbestos exposure correlates with increased mortality risk in MPM patients, suggesting individual susceptibility plays a role.
Area of Science:
- Oncology
- Environmental Health
- Pulmonology
Background:
- Malignant pleural mesothelioma (MPM) is a fatal asbestos-associated cancer with a poor prognosis.
- Treatment decisions for MPM rely on known prognostic factors.
Purpose of the Study:
- To investigate the relationship between asbestos exposure and survival in MPM patients.
- To enhance understanding of asbestos exposure's contribution to MPM prognosis.
Main Methods:
- Studied incident MPM cases from the International Mesothelioma Program.
- Collected data on survival, self-reported asbestos exposure (n=128), and quantitative asbestos fiber burden (n=80).
Main Results:
- Male sex and non-epithelioid histology were associated with reduced survival.
- Quantitative asbestos fiber burden, stratified into low, moderate, and high groups, showed a survival association (p=0.06).
- Low asbestos burden increased mortality risk 3-fold; high burden increased risk 4.8-fold compared to moderate burden.
Conclusions:
- Patient survival in MPM is associated with asbestos fiber burden.
- Individual susceptibility may modify the impact of asbestos exposure on MPM survival.
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