Abstract
BackgroundMalignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking.MethodsIn this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, aiming to describe identified metastatic sites, and correlate with clinical outcomes.Results67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p = 0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without.ConclusionsThis report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.
Highlights
Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues
Baseline characteristics One hundred sixty-four patients referred for consideration of enrollment into early phase clinical trials that were evaluable for metastatic disease sites and survival over the time period
We aimed to describe the local and distant metastatic patterns of advanced MPM patients referred to our dedicated early phase clinical trial unit and correlate with clinical outcome
Summary
Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking. Malignant pleural mesothelioma (MPM) is a cancer of the pleura characterized by local spread and destructive infiltration. MPMs are divided according their histopathological appearances, with epithelioid, comprised of polygonal, oval, or cuboidal cells, the predominant. MPM has been historically described as having a local pattern of disease spread [1,2,3]. Evidence for alternate or unexpected patterns of metastatic spread in MPM have largely been from case reports or autopsy series. A case series from postmortem examinations of 318 patients has quantified rates of liver metastases of 32%, splenic metastases of 11%, thyroid metastases of 7% and brain metastases of 3% [4].
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