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BACKGROUND: The aim of this study was to analyze the clinicopathological features of malignant pleural mesothelioma (MPM) and evaluate the therapeutic measures offered to patients with MPM and their impact on survival. METHODS: Data was retrospectively collected from the medical records of 304 patients who presented to the Department of Clinical Oncology and Nuclear Medicine, Ain Shams University between January 2003 and December 2008. RESULTS: The mean age of patients was 52.1 years (range 24-87 years). One hundred and ninety patients (62.5%) came from endemic areas and/or gave history of occupational asbestos exposure. One hundred and sixty-nine patients received chemotherapy. There was a significant difference between the median survival for patients who received chemotherapy (9 months, 95% CI 7.69-10.30) and those who were offered best supportive care (2 months, 95% CI 0.09-3.91). Other factors that affected the survival negatively were: non-epithelial pathology (P= 0.001); age >50 years (P= 0.012); bad performance status (P= 0.001); non-platinum based chemotherapy (P= 0.0001); and progressive disease (P= 0.000). Cox regression analysis revealed that the factors that predicted shorter survival were patients being offered best supportive care rather than chemotherapy and progressive disease. CONCLUSION: MPM is a growing health problem in Egypt that needs more attention. The current analysis of data reflects the importance of maintaining a high index of suspicion to allow for early diagnosis, especially for cases that live in areas with high asbestos exposure and for people who work in occupations that expose them to asbestos as well as their family members. Prospective randomized trials comparing multimodality approaches to other forms of treatment and including quality of life assessment are warranted.
RESUMO
OBJECTIVE: To study the expression of germinal center B-cell (GCB)/activated B-cell like-related proteins to get optimal stratification of diffuse large B-cell lymphoma (DLBCL) patients, and correlate this with the established clinical and laboratory parameters. METHODS: This study was conducted retrospectively on 30 archival paraffin tissue blocks of DLBCL. All patients were diagnosed between April 2004 and January 2007 at Ain Shams University Hospital and National Cancer Institute, Cairo, Egypt. All patients received anthracycline-based regimens, and none of them received rituximab immunotherapy. Each case included in this study was investigated by immunohistochemical reaction for multiple myeloma-1/interferon regulatory factor-4, B-cell/lymphoma 6, and cluster of differentiation10 monoclonal antibodies. RESULTS: Patients were classified as GCB group (17 patients) and non-GCB group (13 patients). We found a statistically significant association between non-GCB phenotype and performance status (PS) more than 1, high lactate dehydrogenase (LDH) level, advanced international prognostic index (IPI), and poor patient outcome. Non-GCB phenotype, high LDH level, and PS more than 1 were all associated with increased mortality risk. The median survival time was 46.9 months in group A compared to 19.6 months in group B (hazard ratio[HR]=3.30; 95% confidence interval [CI]=0.52-21.10). Using multivariate Cox regression analysis, non-GCB phenotype was found to be the most predicting factor (HR=6.07; 95% CI=1.6-22.9; p=0.008). CONCLUSION: The subclassification of DLBCL into GCB and non-GCB groups using immunohistochemistry may be useful for identifying those patients whose prognosis is so poor that more aggressive therapy can be given at the time of diagnosis.
