De gemiddelde leeftijd van mesothelioompatiënten bij diagnose lijkt toe te nemen. De conditie van deze oudere patiënten is slechter bij diagnose. Dit concluderen Chapman et al. na vergelijking van de resultaten van inwoners van de stad Leeds bij wie tussen 2002 en 2005 de diagnose mesothelioom werd gesteld met eerdere studies in Zuidoost Engeland. De patiënten uit Leeds waren gemiddeld 74 jaar oud bij diagnose en leefden daarna nog gemiddeld 8,9 maanden. Bron: Chapman, A. et al. (2008). Population-based epidemiology and prognosis of mesothelioma in Leeds, United Kingdom. Thorax online, 17 januari 2008, doi:10.1136/thx.2007.081430.
Population-based epidemiology and prognosis of mesothelioma in Leeds, United Kingdom. Thorax online, 17 januari 2008, doi:10.1136/thx.2007.081430.
Abstract
Introduction: Malignant mesothelioma is a fatal neoplasm, which is rapidly increasing in incidence throughout Western Europe. To date there have been no studies reporting upon the natural history and interventional practices on a comprehensive unselected population, as opposed to reports from referral institutions or compensation claimants. We present a population based study capturing data on all patients with mesothelioma presenting within a defined geographical area over a 4 year period in the UK.
Method: Data of all cases occurring in Leeds with a population of 750,000 were collected retrospectively from 2002 to 2003 and prospectively from 2004 through 2005. All patients&rsquo. hospital records and the trust histology database were reviewed, as well as coroner&rsquo.s reports on all patients with a post mortem diagnosis of mesothelioma.
Results: Over the 4 year study period there was a total of 146 cases in Leeds. 77% were male. Median age was 74 (range 36-93). Median survival from diagnosis was 8.9 months. 92% and 8% had a histological or a cytological confirmation respectively. 85% had documented evidence of definite or probable exposure to asbestos. 110/146 (75%) had symptomatic pleural effusions at presentation. Twice the number of patients (42 vs 17) were managed with surgical rather than bedside pleurodesis and these had a lower recurrence rate (14% vs 47%) p=0.02. 122 patients had VATS/cutting CT biopsies or chest drains. 73/122 (60%) had
prophylactic radiotherapy to these sites. There were 7 cases (5%) of tract invasion by tumour and 6 of these had received prophylactic radiotherapy. Median time to seeding was 174 days. 92/146 (63%) had a performance status of 2 or better at diagnosis but only 54/146 were considered fit for chemotherapy. Of these 28 (52%) declined chemotherapy. the overall uptake of chemotherapy or entry into a trial was 18%. No patient had radical surgery.
Conclusion: This comprehensive population based audit has shown that the median age at presentation of malignant mesothelioma is increasing and baseline performance status and survival is worse than in selected series. 37% of patients were considered suitable for palliative chemotherapy but less than 20% accepted this offer. Thorascopic pleurodesis appears to be associated with fewer recurrences. The role of prophylactic radiotherapy to chest drain and biopsy sites needs re-appraisal.