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Asbestos Lung Burden Does Not Predict Survival in Malignant Pleural Mesothelioma: A Necropsy-Based Study of 185 Cases
Pietro Gino Barbieri1, Dario Consonni2, Anna Somigliana3
1Retired from Occupational Health Unit, Local Health Authority and Mesothelioma Registry of Brescia, Brescia, Italy.
Introduction:
Malignant pleural mesothelioma is an asbestos-related disease with poor survival. The prognostic role of histologic subtype is well established. Some studies (without a biological hypothesis) suggested that higher asbestos lung burden is associated with reduced survival.
Methods:
We selected subjects from two series of necropsies: residents in Brescia province (North-West Italy) and workers (or persons living with them) employed in the Monfalcone shipyards (North-East Italy). Asbestos fibers and asbestos bodies in lung samples were counted using a scanning electron and an optical microscope, respectively. Separately in the two series, we analyzed median survival time and fitted multivariable Cox regression models (adjusted for sex, period and age at diagnosis, and histopatholocical diagnosis) to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for three levels of asbestos fiber counts (reference: <1 million fibers/g of dry lung tissue).
Results:
We analyzed 185 necropsies, 83 in Brescia and 102 in Monfalcone. Despite a much higher lung burden in Monfalcone patients, median survival was slightly shorter in Brescia (8.3 mo) than in Monfalcone (10.2 mo). In Brescia, medium (1.0-9.9) and high (10+) fiber burden HRs were 0.91 (95% CI: 0.54-1.53) and 1.23 (95% CI: 0.41-3.70), respectively. In Monfalcone, the corresponding HRs were 1.18 (95% CI: 0.59-2.35) and 1.63 (95% CI: 0.77-3.45), respectively.
Conclusions:
No relationship between asbestos lung burden and survival was found. Histologic subtype was the strongest prognostic determinant.
Insights
This study found no link between asbestos lung burden and survival in mesothelioma patients. Histologic subtype, not fiber count, is the key factor for prognosis in this asbestos-related disease.
Area of Science:
- Occupational Medicine
- Pathology
- Environmental Health
Background:
- Malignant pleural mesothelioma is an asbestos-related cancer with poor prognosis.
- Histologic subtype is a known prognostic factor.
- Previous studies suggested a link between asbestos lung burden and survival, but lacked a biological basis.
Purpose of the Study:
- To investigate the relationship between asbestos lung burden and survival in patients with malignant pleural mesothelioma.
- To determine if asbestos fiber count in lung tissue is a prognostic indicator.
Main Methods:
- Analysis of 185 necropsies from Brescia and Monfalcone, Italy.
- Quantification of asbestos fibers and bodies in lung tissue using microscopy.
- Multivariable Cox regression models to assess survival based on asbestos fiber burden, adjusted for clinical factors.
Main Results:
- No significant relationship was observed between asbestos lung burden and survival in either study group.
- Median survival was 8.3 months in Brescia and 10.2 months in Monfalcone, despite higher lung burden in Monfalcone.
- Hazard ratios for medium and high asbestos fiber burdens did not indicate increased mortality risk.
Conclusions:
- Asbestos lung burden is not a significant prognostic determinant for malignant pleural mesothelioma.
- Histologic subtype remains the most critical factor influencing patient survival.
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