Risk Factors and Survival Analysis of Cases of Malignant Pleural Mesothelioma in Ain Shams University Hospital

Abstract

SUMMARY M PM is a growing health problem that needs more attention. Environmental and household exposure to asbestos plays an important role in occurrence of malignant pleural mesothelioma as well as exposure to smoking. Mesothelioma in Egypt is mainly concentrated in areas of high environmental pollution. The prognosis of MPM is poor. So, this study aimed to identify risk factors of malignant pleural mesothelioma in patients attending outpatient clinic in clinical oncology department in Ain Shams university hospital and to carry out survival analysis. The study was conducted through interviewing 90 cases attending the outpatient clinic in the clinical oncology department in Ain Shams university hospital using an interview questionnaire. In this study patients in critical condition who need hospitalization or palliative treatment were excluded. A similar number of controls from the relatives of the inpatients at obstetrics and gynecology hospital filled the same questionnaire. The cases and controls were matched for age and gender. Patients were then followed up for two years starting from the date of pathologically confirmed diagnosis. Statistical analysis was done. Regarding the sociodemographic characteristics of the study population the mean age of the cases was 54.72 ±10.95 years where female: male ratio was 1:1.14. In Qalyubia including Shoubra El-Khaymah 41(45.6%) of the cases lived and 6 (6.7%) cases lived in Helwan which are considered famous industrial areas. 49(54.4%) of cases had factories near their residential location. There was a statistically significant difference between cases and controls regarding household exposure to asbestos through cleaning of clothes of somebody sharing housing who works in asbestos related occupation. 43.3% of cases had history of cigarette smoking with an average of 22 cigarettes per day. The mean age of initiation of smoking was 24 years. Factors that were significantly associated with increased risk for malignant pleural mesothelioma were history of smoking, living in an industrial area as Qalyubia and living with somebody who works in high risk occupation. Regarding the survival of patients of MPM The mean survival duration of all cases (n=90) was 24.49 months. The mean survival was 24.75 months for males and 21.94 months for females. Mean survival duration for patients >50 was 22.28 months and for patients ≤50 mean survival duration was 25.26 months. The difference was statistically significant. Mean survival duration was 24.01, 24.21 and 21.83 months for patients treated with chemotherapy, radiotherapy and a combination of both respectively. Age and gender were prognostic factors for survival duration of MPM. In conclusion, Environmental and household exposure to asbestos plays an important role in occurrence of malignant pleural mesothelioma. Mesothelioma in Egypt is mainly concentrated in areas of high environmental pollution. Egypt should adopt more strict measures to reduce pollution and occurence of MPM. In addition, accurate recording and the development of a registration system for data in medical records are required to determine the true size and scope of this environmental problem in Egypt.