Malignant pleural mesothelioma in Singapore

To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore.

A retrospective case note review of patients diagnosed with MPM between 1997 and 2007. Overall survival (OS), locoregional recurrence-free survival (LRS) and metastasis-free survival (MFS) were estimated using Kaplan Meier method and comparison were done using log rank test. Multivariate analysis was not done due to the small number of patients.

There were 39 patients diagnosed with MPM. Fifty-nine percent of patients presented with Stage III and IV disease. Eight (21%) patients had surgery with 2 patients receiving trimodality treatment and adjuvant chemotherapy respectively. Three patients received adjuvant RT and one patient had no adjuvant therapy. Twelve patients received palliative RT or chemotherapy. Median follow-up was 27.0 weeks. Median overall survival (OS) for all patients was 8.0 months (95% CI 6.3-9.7). One-year and 2-year OS were 25.6% and 6.4% respectively. Thirty-eight patients died of progressive disease and one patient died of other cause. Locoregional recurrences and distant metastases occurred in 3/8 and 5/8 surgically treated patients respectively. Overall, distant metastases occurred in 44% of patients. Surgery did not affect survival outcomes although patients with dual modality treatment showed a trend towards improved survival. Epithelioid tumours had better prognosis (median OS 10.2 months) compared to biphasic (median OS 8.0 months) and sarcomatoid tumours (median OS 1.4 months).

Future management of MPM will need to emphasize on both locoregional and systemic control and hence, inclusion of patients in clinical trials for multimodality treatment should be encouraged.