Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort

Our plain-English summary of Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort, by W. Amin, F. Linkov, D.P. Landsittel, et al (F1000Research, 2018).

The study

• Authors: W. Amin, F. Linkov, D.P. Landsittel, J.C. Silverstein, W. Bashara, C. Gaudioso, M.D. Feldman, H.I. Pass, J. Melamed, J.S. Friedberg, M.J. Becich
• Journal: F1000Research
• Published: 2018;7:1184
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma (MM) is a rare but deadly malignancy with about 3,000 new cases being diagnosed each year in the US. Very few studies have been performed to analyze factors associated with mesothelioma survival, especially for peritoneal presentation. The overarching aim of this study is to examine survival of the cohort of patients with malignant mesothelioma enrolled in the National Mesothelioma Virtual Bank (NMVB). Methods: 888 cases of pleural and peritoneal mesothelioma cases were selected from the NMVB database, which houses data and associated biospecimens for over 1400 cases that were diagnosed from 1990 to 2017. Kaplan Meier's method was performed for survival analysis. The association between prognostic factors and survival was estimated using Cox Hazard Regression method and using R software for analysis. Results: The median overall survival (OS) rate of all MM patients, including pleural and peritoneal mesothelioma cases is 15 months (14 months for pleural and 31 months for peritoneal). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were younger than 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and having combination treatment of surgical therapy with chemotherapy. Combined surgical and chemotherapy treatment was associated with improved survival of 23 months in comparison to single line therapies. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with current available treatment options. Our findings show that combined surgical and chemotherapy treatment in peritoneal mesothelioma is associated with improved survival compared to local therapy alone.

In plain English

This retrospective review examined survival in 888 people with pleural (740) or peritoneal (148) malignant mesothelioma from the National Mesothelioma Virtual Bank's northeastern United States centers. Asbestos exposure was self-reported by 413 of 531 people with that information. Overall median survival was 15 months. It was 22 months (95% CI 18 to 30) for women versus 14 (13 to 16) for men, 59 months (34 to 91) for ages 18 to 44 versus 10 (9 to 13) for ages 75 and over, and 20 months (16 to 31) with no reported asbestos exposure versus 15 (13 to 17) with reported exposure. Among treatment groups, surgery plus chemotherapy had the longest median survival, 23 months (95% CI 21 to 27); adding radiation did not improve survival. The authors concluded that age under 45, female gender, epithelioid subtype, stage I (staging was analyzed only in pleural cases), peritoneal site and surgery with chemotherapy were favorable prognostic factors. They noted that exposure was self-reported and that their patients may not represent all mesothelioma patients, many of whom are not surgical candidates.

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: Retrospective review of a cohort from a research database, using Kaplan-Meier survival curves and univariable and multivariable Cox proportional hazards regression
• Who was studied: 888 patients with histologically confirmed pleural (740) or peritoneal (148) malignant mesothelioma (683 male, 205 female) from the National Mesothelioma Virtual Bank. Patients were enrolled through New York University, University of Pennsylvania, University of Maryland, Roswell Park Cancer Institute and University of Pittsburgh Medical Center, and were diagnosed between 1999 and 2017 according to the Methods.
• Exposure: Self-reported history of asbestos exposure, reported yes in 413 of 531 patients with this information. No fiber types, products or doses are given. Smoking history, age, sex, race, tumor site, histology, stage and treatment type (surgery alone, surgery plus chemotherapy, or surgery plus chemotherapy and radiation) were also analyzed.
• Main results:
  • Median overall survival of the whole cohort was 15 months.
  • Median survival was 59 months (95% CI 34 to 91) for patients aged 18 to 44, compared with 10 months (95% CI 9 to 13) for patients aged 75 and over.
  • Median survival was 22 months (95% CI 18 to 30) for females, compared with 14 months (95% CI 13 to 16) for males.
  • Patients with no reported asbestos exposure had a median survival of 20 months (95% CI 16 to 31), compared with 15 months (95% CI 13 to 17) for those reporting exposure.
  • In the unadjusted Cox analysis, no reported asbestos exposure had a hazard ratio of 0.61 (95% CI 0.48 to 0.78, p less than 0.001) compared with reported exposure.
  • Median survival was 18 months (95% CI 17 to 21) for the epithelioid subtype, compared with 10 months (95% CI 9 to 13) for the biphasic subtype.
  • Among the treatment groups, patients treated with surgery plus chemotherapy had the most favorable median survival, 23 months (95% CI 21 to 27). Adding radiation did not improve survival.
  • Among pleural cases, median survival was 20 months (95% CI 18 to 25) for stage I, compared with 12 months for stages III and IV.
  • Patients with peritoneal mesothelioma who received surgery and chemotherapy had a median survival of 28 months (95% CI printed as 28 to 45), compared with 14 months (95% CI 11 to 17) for patients with pleural mesothelioma.
  • In the multivariable analysis, younger age, female gender, peritoneal site, surgery plus chemotherapy, no smoking history, early stage (I and II) and epithelial histology were predictors of more favorable survival.
• The authors' conclusion: The authors concluded that age younger than 45, female gender, epithelioid histological subtype, stage I disease (staging analyzed for pleural cases), peritoneum as the primary site, and surgery combined with chemotherapy were favorable prognostic factors in this cohort.
• Limitations the authors state:
  • There were no detailed data on the specific type of surgery.
  • Asbestos exposure data were self-reported and not confirmed by radiologic analyses.
  • Patients' recall of the duration and details of their exposure may have introduced bias.
  • The population may not represent all mesothelioma patients, because many patients are not good surgical candidates.
  • Possible selection bias, because few patients were enrolled from outside the northeastern sites in the network.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Peritoneal Mesothelioma, Median Overall Survival, Epithelioid, Histological Subtype, Chemotherapy, Overall Survival.

Related studies

• National Mesothelioma Virtual Bank: a standard based biospecimen and clinical data resource to enhance translational research — W. Amin, A.V. Parwani, et al. (2008)
• National Mesothelioma Virtual Bank: A Platform for Collaborative Research and Mesothelioma Biobanking Resource to Support Translational Research — W. Amin, A.V. Parwani, et al. (2013)
• Industry, occupation, and exposure history of mesothelioma patients in the U.S. National Mesothelioma Virtual Bank, 2006-2022 — Y. Gao, J.M. Mazurek, et al. (2023)
• The development and deployment of Common Data Elements for tissue banks for translational research in cancer - an emerging standard based approach for the Mesothelioma Virtual Tissue Bank — S.K. Mohanty, A.T. Mistry, et al. (2008)
• Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma — H. Kaya, C. Sezgı, et al. (2014)
• Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis — P. Henschke, L.C. Guglielmetti, et al. (2024)

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