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Factoren die een aanwijzing kunnen geven over de levensverwachting van mesothelioompatiënten zijn: het soort mesothelioom, de locatie van de tumor in het lichaam, sekse, rookgedrag en de conditie en symptomen van de patiënt. Een Behandeling met een combinatie van chemo-, radiotherapie en operatieve verwijdering van de tumor lijkt het best te werken, hoewel meer onderzoek nodig is. Dit concluderen Amerikaanse onderzoekers na analyse van medische gegevens van 945 patiënten die tussen 1990 en 2005 in een New Yorks ziekenhuis voor mesothelioom waren behandeld. Flores, R.M. et al., (2007). Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center. Journal of Thoracic Oncology, 2, oct. 2007, p. 957-965.

Flores, R.M. et al., (2007). Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center. Journal of Thoracic Oncology, 2, oct. 2007, p. 957-965.
Abstract:
Introduction: Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population.
Methods: Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value &lt. 0.05 was considered statistically significant.
Results: From 1990 to 2005, 945 patients were identified: 755 men, 190 women. median age, 66 years (range, 26&ndash.93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p = 0.003).
Conclusions: In addition to tumor histology and pathologic stage,
predictors of survival include gender, asbestos exposure, smoking,
symptoms, laterality, and clinical stage. Surgical resection in a
multimodality setting was associated with improved survival.

Biochemicus Peter Duesburg stelt dat schade aan chromosomen de directe oorzaak is van het ontstaan van kanker en niet een bij-effect van de versnelde celdeling. Dat geldt vooral voor kankersoorten die door gevaarlijke stoffen als asbest ontstaan. De menselijke cel bevat 40.000 genen die in 23 verschillende groepen zijn verdeeld, genaamd chromosomen. Bron: The Irish Times, 16 augustus 2007.

Finse onderzoekers constateerden dat aan asbest blootgestelde bouwvakkers die in herfst of winter geboren zijn relatief vaker fibrose aan de longen hebben dan degenen die in lente of zomer geboren zijn. Een mogelijke verklaring is dat herfst- en winterkinderen vlak na de geboorte vaker infecties aan de luchtwegen hebben die hen gevoeliger maken voor de effecten van asbestvezels later in hun leven. Bron: Hannu, T. et al., (2007). Season of birth and lung fibrosis among workers exposed to asbestos. Chronobiology Intenational 24(3):539-552.
Hannu, T. et al., (2007). Season of birth and lung fibrosis among workers exposed to asbestos. Chronobiology Intenational 24(3):539-552.
The season of birth has been suggested to influence the development of some diseases, but its role in lung fibrosis seems to not have been studied previously. The aim of this study was to investigate the relation between the season of birth and fibrotic abnormalities as detected radiologically in high-resolution computed tomography (HRCT) among workers exposed to asbestos. The HRCT examination was performed on 528 study subjects. Multiple ordinal regression analysis adjusting for covariates was used to study the relations between birth month or season and radiological fibrosis signs. Subjects born in autumn or winter had more extensive fibrotic changes than those born in spring or summer. This applied to all fibrotic changes, apart from subpleural nodules, but only the overall fibrosis score, septal lines, and honeycombing showed statistically significantly higher values in comparison to spring births. The highest scores were detected among those born in autumn and winter months (September-February). These results suggest that there are differences in fibrotic radiological abnormalities according to the season of birth in adults exposed to asbestos. Several hypotheses could explain the observed findings, including the effects of early respiratory infections, cold temperature, and differences in air pollution levels, as well as some metabolic and hormonal effects.

Een artikel in het Britse blad Nursing Standard beschrijft de specifieke uitdagingen voor verpleegkundigen bij de zorg van mesothelioompatiënten, een groep waarmee zij steeds meer in aanraking komen omdat het aantal patiënten nog steeds toeneemt. Maligne mesothelioom vereist een speciale aanpak omdat de ziekte zowel medische als juridische gevolgen heeft. In het Verenigd Koninkrijk moet de ziekte bijvoorbeeld gemeld worden bij de politie. Er bestaan geen nationale richtlijnen voor de behandeling. Nursing Standard, 21, nr. 42, juni 2007, pag. 24-25.

Slechts de helft van de Australische asbestslachtoffers met mesothelioom krijgt behandeling met het medicijn Alimta vergoed. Het hangt af van het gebied waarin men woont. Bron: The Advertiser, 29 augustus 2007

In een Italiaans onderzoek werden bij 32 van 169 mesothelioompatiënten (19%) andere primaire tumoren gevonden. Bij al deze pati&euml.nten was asbestblootstelling aanwijsbaar. De onderzoekers adviseren nader onderzoek naar gemeenschappelijke oorzaken van maligne mesothelioom en bepaalde andere tumoren. Bron: Bianchi, C & T. , (2007). Malignant mesothelioma of the pleura and other malignancies in the same patient. Tumori, 93, 19-22.

Bianchi, C &amp. T. , (2007). Malignant mesothelioma of the pleura and other malignancies in the same patient. Tumori, 93, 19-22.

Aims and background: The co-existence of mesothelioma, mostly asbestos-related, and other primary malignancies has repeatedly been reported. The present study evaluated the frequency of such an occurrence. Methods: In the period October 1979-June 2002, 215 cases of malignant pleural mesothelioma were diagnosed at the Hospital of Monfalcone, Italy. All the cases of the above series, examined at necropsy (169), were included in the study. Occupational histories had been obtained from the patients or from their relatives by personal or telephone interviews. In 132 cases, asbestos bodies were isolated after chemical digestion of lung samples. The thoracic cavities were examined for pleural plaques. Results: Additional malignancies were observed in 32 cases (18.9%). Multiple tumors were synchronous in 22 cases, metachronous in 8 cases, and synchronous and metachronous in 2. Four different tumors were found in 2 cases, 3 malignancies were detected in 6 patients, and 2 malignancies in the remaining 24. The most frequent additional malignancies were prostate adenocarcinoma (7 cases), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5 cases), bladder carcinoma (4 cases), kidney carcinoma (4 cases), large bowel carcinoma (4 cases), and liver cell carcinoma (4 cases). All the patients had histories of exposure to asbestos, mostly in shipbuilding. Lung asbestos body burdens ranged between 60 and 230,000 per gram of dried tissue. Pleural plaques were found in 26 cases. Conclusions: In contrast with other series of the literature, in the present cases the co-existence of mesothelioma and other malignancies appeared as a relatively frequent event. The lack of a control group does not allow definite conclusions about the meaning of the occurrence. However, the co-existence of certain tumors with asbestos-related mesothelioma suggests that mesothelioma and associated malignancies might share some etiologic factors (asbestos and others)

De Britse gezondheidsautoriteit NICE is teruggekomen op een eerdere uitspraak dat het medicijn Alimta niet door de National Health Service (NHS) vergoed zou moeten worden. Een jaar geleden oordeelde NICE dat er niet genoeg bewijs was dat behandeling met dit medicijn beter werkt dan voordeliger behandelingen. Artsen, patiëntengroepen en farmaceut Ei Lily gingen tegen deze uitspraak in beroep. Nu wordt in een richtlijn vermeld dat chemotherapeutische behandeling met een combinatie van Alimta en Cisplatine aanbevolen is en door de NHS moet worden vergoed. Bron: The Times, 9 juli 2007.

Een Schotse gezondheidsdienst heeft verzuimd een mesothelioompatiënt te informeren over de mogelijkheden van schadevergoeding en aan welke voorwaarden daarvoor moet worden voldaan. Het slachtoffer overleed drie maanden na diagnose zonder dat aan de voorwaarde van een biopsie ter herbeoordeling van de diagnose was voldaan. Pas na zijn dood hoorde zijn vrouw over de mogelijkheden om in aanmerking te komen voor een schadevergoeding. De Schotse ombudsman Publieke Diensten oordeelt dat de Gezondheidsdienst excuses moet aanbieden aan de weduwe. Bron: The Herald, 21 juni 2007.

Biomerkers als Soluble mesothelin-related peptide (SMRP), osteopontine en megakaryocyte potentiating factor (MPF) zijn nog niet voldoende accuraat om cytohistologie als gouden standaard voor de diagnose van maligne mesothelioom te vervangen. Aldus een overzichtsartikel en een onderzoeksverslag. Biomerkers zijn eiwitten in het bloed die iets kunnen zeggen over de aanwezigheid of verloop van sommige ziektes. Bron: Scherpereel, A. &amp. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339. Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35-343.
Scherpereel, A. &amp. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339-343.

Purpose of review

Mesothelioma is an incurable cancer and its global incidence continues to increase. There has been strong interest in the search for a biomarker that would be of value for the diagnosis, prognosis and disease monitoring of mesothelioma. Large series evaluating the use of novel candidate markers have recently been published.

Recent findings

To date, global gene profiling studies have failed to find a molecule that reliably captures all subtypes of mesothelioma, and differentiates it from benign pathologies and metastatic carcinomas. Soluble mesothelin-related peptide (SMRP), osteopontin and megakaryocyte potentiating factor have been assessed as markers. SMRP testing is clinically available and provides reasonable diagnostic sensitivity and specificity when applied to serum or pleural fluid. Elevated SMRP levels can occur in metastatic, especially ovarian and pancreatic, adenocarcinomas. False negatives are common with sarcomatoid mesothelioma. SMRP levels may reflect tumor load and disease progression. The role of SMRP in predicting mesothelioma development in subjects exposed to asbestos has raised interest. Osteopontin lacks specificity as a diagnostic marker for mesothelioma but may have value in disease monitoring.

Summary

The proposed markers have insufficient accuracy to replace cytohistology as the gold standard for diagnosis for mesothelioma. Elevated SMRP levels raise suspicion of mesothelioma although negative values do not exclude disease. Its role in disease monitoring in patients and in predicting disease development in at-risk individuals warrant further study.



Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35

Abstract

Purpose: Malignant mesothelioma is a highly aggressive tumor and is often diagnosed too late for a curative treatment.We compared diagnostic and prognostic values ofmesothelin and osteopontin in172 patients suspected ofmalignant pleuralmesothelioma (MPM) and in a control group

of 112 asymptomatic asbestos-exposed subjects.

Experimental Design: Osteopontin and mesothelin were assayed with commercial ELISA kits in a series of 43 patients with pleural metastases of various carcinomas, 33 patients with benign pleural lesions associated with asbestos exposure, 96 patients with MPMs, and 112 asbestos-exposed healthy subjects. Results were correlated with patient’s diagnosis and survival.

Results: Serumosteopontin level was higher in MPMpatients compared with healthy asbestos exposed subjects and had a good capability to distinguish between these two populations. However, osteopontin was unable to distinguish between MPM and pleural metastatic carcinoma or benign pleural lesions associated with asbestos exposure. Neither plasma nor pleural fluid osteopontin were more powerful in this respect. Serum mesothelin had a good ability for diagnosing MPM but was unable to identify patients with nonepithelioid mesothelioma subtypes. Survival analysis identified tumor histologic subtype along with serum osteopontin and serum mesothelin as independent prognostic factors in mesothelioma patients.

Conclusions: Osteopontin has a lower diagnostic accuracy than mesothelin in patients suspected of MPM. Insufficient specificity limits osteopontin utility as diagnosticmarker. Bothmolecules have a potential value as prognostic markers.

Deskundigen analyseren in het blad Oncogene de meest interessante presentaties die gegeven werden op de 8ste bijeenkomst van de International Mesothelioma Interest Group (IMIG). een groep medici met bijzondere belangstelling voor de ziekte maligne mesothelioom. Zij concluderen dat op dit moment operatieve verwijdering van de tumor in combinatie met andere behandelvormen (multimodale therapie) de beste kansen op lange termijn overleving geven. Bron: Carbone, M. et al. (2007). Eighth International Mesothelioma Interest Group. Oncogene advance online publication, 14 may 2007. doi:10.1038/sj.onc.1210515.
Carbone, M. et al. (2007). Eighth International Mesothelioma Interest Group. Oncogene advance online publication, 14 may 2007. doi:10.1038/sj.onc.1210515.

Abstract

The eighth International Mesothelioma Interest Group (IMIG) meeting was held in Chicago, IL, United States, in 19-22 October 2006 to discuss mesothelioma & the cancer often linked to asbestos exposure. It is a very

aggressive malignancy with a median survival of less than 1 year from diagnosis. Millions of people have been exposed worldwide to asbestos, especially during the second half of the twentieth century when asbestos use increased significantly. The tons of asbestos utilized in the past remain a health hazard for current and future generations because asbestos is difficult to be disposed off. This makes asbestos and mesothelioma research a public health issue in addition to a medical problem. Moreover, the very high costs of asbestos litigation have a significant impact on the whole economy. In the United States, up until 2001, defendant companies had paid 54 billion dollars in claims and estimated future liabilities ranged from 145 to 210 billion. Therefore, asbestos research is of great interest to a large audience that includes patients, millions of asbestos-exposed individuals, scientists, physicians,

public health officials, politicians, unions of asbestos workers, lawyers and the public at large. During the past few years, there has been significant progress in understanding the process of mineral fiber carcinogenesis

and mesothelioma pathogenesis. With improved understanding of the pathogenesis of mesothelioma, new diagnostic, preventive and therapeutic options are being developed. A total of 247 papers were presented at the IMIG: the abstracts of these presentations were published in Lung Cancer, Supplement 1, October 2006. Here, experts in different disciplines critically review some of the most exciting presentations of the IMIG meeting. The result is a comprehensive review of the research field of asbestos carcinogenesis and mesothelioma, and of the progress that has been made in recent years in both basic and clinical sciences.