Malignant Pleural Mesothelioma in Singapore


Aim: To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) inSingapore. Methods and Materials: A retrospective case note review of patients diagnosed with MPM between1997 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. Multivariateanalysis was not done due to the small number of patients.
Results: There were 39 patients diagnosed with MPM.Fifty-nine percent of patients presented with Stage III and IV disease. Eight (21%) patients had surgery with2 patients receiving trimodality treatment and adjuvant chemotherapy respectively. Three patients receivedadjuvant 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 diseaseand one patient died of other cause. Locoregional recurrences and distant metastases occurred in 3/8 and 5/8surgically treated patients respectively. Overall, distant metastases occurred in 44% of patients. Surgery didnot affect survival outcomes although patients with dual modality treatment showed a trend towards improvedsurvival. Epithelioid tumours had better prognosis (median OS 10.2 months) compared to biphasic (median OS8.0 months) and sarcomatoid tumours (median OS 1.4 months).
Conclusion: Future management of MPM willneed to emphasize on both locoregional and systemic control and hence, inclusion of patients in clinical trialsfor multimodality treatment should be encouraged.