Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade

Our plain-English summary of Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade, by A. Bangolo, P. Fwelo, A. Jarri, et al (Journal of Community Hospital Internal Medicine Perspectives, 2024).

The study

• Authors: A. Bangolo, P. Fwelo, A. Jarri, S.P. Pulipaka, V.K. Nagesh, N. Wadhwani, B. Alqinai, S. Sohail, G. Keshav, A.A. Chacko, A. Menon, L. Periel, Z.S. Siddiqui, B. Pyakurel, S. Kunnel, M. Maturasingh, G. Quirequire, J. Gudapati, A. Hoque, Z. Habib, V. Rao, J.K. Grewal, A. Lo, S. Weissman
• Journal: Journal of Community Hospital Internal Medicine Perspectives
• Published: 2024;14(5):14-20
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant Pleural Mesothelioma (MPM) is a primary pleural tumor with scarce prognostic data estimates given its rarity. This study aims to explore the epidemiologic and survival predictors amongst patients with MPM, extending from the largest and most recent study conducted between 1973 and 2009.

Methods: 3384 patients diagnosed with MPM between 2010 and 2017 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors.

Results: Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. Nonmalignant pleural effusion, based on histology, was associated with higher CSM (HR = 1.22, 95% CI 1.05-1.4, p < 0.05).

Conclusion: Fibrous mesothelioma, older age, and distant disease were associated with increased mortality. All intervention strategies were associated with improved survival outcomes. Earlier diagnosis may improve outcomes, as available interventions are associated with lower mortality when feasible at diagnosis. The study paves the way for further prospective and retrospective studies to focus on the identification of patient subsets that may benefit from early mesothelioma screening.

© 2024 Greater Baltimore Medical Center.

In plain English

This study used a US cancer registry, the SEER database, to look back at 3,384 patients diagnosed with malignant pleural mesothelioma between 2010 and 2017. It examined which patient, tumor and treatment features were linked to death from any cause and to death from mesothelioma. Asbestos exposure was not among the variables the authors analyzed. Most patients were male (77.16%), and 71.60% were diagnosed at distant stage. In the adjusted analysis, the following were associated with higher overall mortality: male gender (hazard ratio 1.24, 95% CI 1.14 to 1.37), age 80 or over compared with 0 to 39 (2.17, 1.41 to 3.35), fibrous compared with epithelioid mesothelioma (2.21, 1.95 to 2.51), and distant compared with localized stage (1.55, 1.34 to 1.81). Surgery, chemotherapy, and surgery with or without radiation were associated with lower mortality. Radiation (yes versus no) was not statistically significant in the adjusted analysis. Benign pleural effusion, compared with none, was associated with higher mesothelioma-specific mortality (1.22, 1.05 to 1.4). The authors concluded that treatment improves mortality but that most cases are found at advanced stages. They noted that the database lacked immunotherapy and comorbidity data and had incomplete chemotherapy data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based retrospective cohort study using SEER registry data (November 2020 submission, 17 registries)
• Who was studied: 3,384 US patients with malignant pleural mesothelioma diagnosed 2010 to 2017, drawn from the SEER database; patients with unknown age, race or stage were excluded
• Exposure: Asbestos and other environmental or occupational exposures were not among the variables analyzed. The predictors examined were age, gender, race, origin, stage, histologic subtype, residential area, income, marital status, surgery, chemotherapy, radiation and pleural effusion.
• Main results:
  • Of the whole cohort, 77.16% were male and 60.17% were diagnosed at age 60 to 79
  • In the whole cohort, 2,423 patients (71.60%) were diagnosed at distant stage
  • In the whole cohort, 365 patients (10.79%) had no pleural effusion at diagnosis
  • In the whole cohort, epithelioid mesothelioma was the most common subtype: 1,414 patients (41.78%)
  • Male compared with female patients, adjusted analysis: HR 1.24 (95% CI 1.14 to 1.37) for overall mortality and HR 1.25 (1.13 to 1.38) for mesothelioma-specific mortality
  • Patients aged 80 or over compared with those aged 0 to 39, adjusted analysis: HR 2.17 (1.41 to 3.35) for overall mortality and HR 2.02 (1.29 to 3.15) for mesothelioma-specific mortality
  • Fibrous compared with epithelioid mesothelioma, adjusted analysis: HR 2.21 (1.95 to 2.51) for overall mortality and HR 2.24 (1.97 to 2.55) for mesothelioma-specific mortality
  • Biphasic compared with epithelioid mesothelioma, adjusted analysis: HR 1.58 (1.39 to 1.79) for overall mortality and HR 1.58 (1.39 to 1.81) for mesothelioma-specific mortality
  • Distant compared with localized stage, adjusted analysis: HR 1.55 (1.34 to 1.81) for overall mortality and HR 1.59 (1.36 to 1.87) for mesothelioma-specific mortality
  • Surgery (yes versus no), adjusted analysis: HR 0.76 (0.69 to 0.84) for overall mortality and HR 0.73 (0.66 to 0.81) for mesothelioma-specific mortality
  • Chemotherapy (yes versus no), adjusted analysis: HR 0.74 (0.69 to 0.80) for overall mortality and HR 0.77 (0.71 to 0.83) for mesothelioma-specific mortality
  • The category labelled surgery with or without radiation in the table (yes versus no), adjusted analysis: HR 0.68 (0.54 to 0.86) for overall mortality and HR 0.68 (0.53 to 0.86) for mesothelioma-specific mortality
  • Radiation (yes versus no) was not statistically significant in the adjusted analysis: HR 1.09 (0.93 to 1.29) for overall mortality and HR 1.13 (0.96 to 1.35) for mesothelioma-specific mortality
  • Benign pleural effusion compared with no effusion, adjusted analysis: HR 1.22 (1.05 to 1.4) for mesothelioma-specific mortality; for overall mortality, HR 1.15 (0.99 to 1.32), which was not statistically significant
  • Annual income of $75,000 or more compared with less than $55,000 was not statistically significant in the adjusted analysis: HR 0.96 (0.84 to 1.11) for overall mortality and HR 0.99 (0.85 to 1.15) for mesothelioma-specific mortality
• The authors' conclusion: The authors concluded that treatment improves overall and cancer-specific mortality, but that most cases are found at advanced stages, resulting in a poor prognosis. They called for further studies of monitoring and early intervention strategies.
• Limitations the authors state:
  • The SEER database lacked data on immunotherapy and comorbidities, and its chemotherapy data were incomplete

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epidemiology, SEER, Hazard Ratio, Epithelioid, Mesothelioma, Pleural Effusion, Histology.

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