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S43 Preliminary results of the Meso-ORIGINS feasibility study: retrospective element regarding BAPE-mesothelioma evolution rate
  1. K Ferguson1,
  2. R Mercer2,
  3. J King3,
  4. K Marshall3,
  5. S Tsim4,
  6. N Maskell4,
  7. M Evison3,
  8. N Rahman2,
  9. K Blyth5
  1. 1Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Churchill Hospital, Oxford, UK
  3. 3University Hospital of South Manchester, Manchester, UK
  4. 4Macmillan Cancer Support, Glasgow, UK
  5. 5Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK

Abstract

Introduction Malignant Pleural Mesothelioma (MPM) is presaged by Benign Asbestos Pleural Effusion (BAPE) in some patients. In a future study (called Meso-ORIGINS) we will collect longitudinal BAPE-MPM tissue pairs in patients who develop MPM following BAPE and use this material in the PREDICT-Meso CRUK Accelerator programme. PREDICT-Meso will define the key biological events that drive or permit evolution of MPM, generate new pre-clinical models and define new therapeutic targets. At initial planning, the only data reporting BAPE-MPM evolution rate were derived from a single-centre study (n=44 BAPE patients) with wide confidence intervals around the estimate reported (12% (95%CI 5%–24%, Davies et al, 2010). Here we report the preliminary findings of a retrospective analysis performed as part of the multi-centre Meso-ORIGINS feasibility study. The primary objective was to define the BAPE-MPM evolution rate more precisely, to generate a reliable sample size estimate for Meso-ORIGINS.

Methods Patients were identified from databases in Glasgow, Oxford, Manchester & Bristol. Eligibility required 2-years complete follow-up data following a diagnosis of BAPE, which was defined as asbestos exposure (history or imaging) plus compatible histology (benign fibrinous pleurisy, non-specific pleuritis, atypical mesothelial proliferation). Comprehensive clinical data were recorded including demographics, radiological findings, blood and pleural fluid results. These will be used to build a logistic regression model for higher MPM evolution risk, to refine the eligibility criteria of the Meso-ORIGINS study. BAPE-MPM evolution was defined as any diagnosis of MPM within 2-years of the diagnosis of BAPE.

Results Data collection is complete in 3 of 4 centres. At the time of writing, data collection is complete in 207 eligible patients with BAPE. Mean (SD) age is 71.8 (9.7) years. 97% of cases are male. On baseline imaging, 64% had pleural plaques and 28% cases had features suggestive of pleural malignancy. The BAPE-MPM evolution rate was 30/207 or 14.5% (95%CI 9.9–19.9%).

Conclusions The final results of this study will allow optimal design of the Meso-ORIGINS study, which is a major component of the PREDICT-Meso CRUK Accelerator programme. If the BAPE-MPM progression rate is similar to the provisional rate reported here, this would translate into a feasible sample size.

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