Life Expectancy in Pleural and Peritoneal Mesothelioma

Our plain-English summary of Life Expectancy in Pleural and Peritoneal Mesothelioma, by R. Shavelle, K. Vavra-Musser, J. Lee, et al (Lung Cancer International, 2017).

The study

• Authors: R. Shavelle, K. Vavra-Musser, J. Lee, J. Brooks
• Journal: Lung Cancer International
• Published: 2017;2017:2782590
• Cited by: 53 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background. Mesothelioma is a rare cancer with a historically dire prognosis. We sought to calculate life expectancies for patients with pleural or peritoneal mesothelioma, both at time of diagnosis and several years later, and to examine whether survival has improved in recent years. Methods. Data on 10,258 pleural and 1,229 peritoneal patients from the SEER US national cancer database, 1973-2011, were analyzed using the Cox proportional hazards regression model. Results. The major factors related to survival were age, sex, stage, grade, histology, and treatment. Survival improved only modestly over the study period: 0.5% per year for pleural and 2% for peritoneal. Conclusions. Life expectancies were markedly reduced from normal, even amongst 5-year survivors with the most favorable characteristics and treatment options.

In plain English

This study used the US SEER national cancer database to estimate survival and life expectancy for people diagnosed with mesothelioma from 1973 to 2011. The authors analyzed 10,258 pleural and 1,229 peritoneal mesothelioma patients aged 40 or older using statistical survival models. The study did not look at asbestos exposure. Age, sex, stage, histology (tumor cell type) and treatment were related to survival. For example, among pleural cases, men had 28% higher mortality than women, all else being equal. Survival improved only slightly over the study period: about 0.5% per year in pleural cases and roughly 2% per year in peritoneal cases. Patients given both radiation and surgery had lower risk. Treatment was not randomized, however, and the authors said this may reflect healthier patients receiving both treatments. One example group was white patients with the epithelial type, diagnosed in 2010 and treated with radiation and surgery. In that group, a 40-year-old man with distant-stage pleural mesothelioma had an estimated life expectancy of about 4 years at diagnosis, compared with 39 years in the general population. The authors concluded that life expectancy was much reduced from normal, even for people who had already survived 2 or 5 years. They noted that SEER lacked information on chemotherapy and other illnesses.

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 analysis of US national cancer registry (SEER) data, using Kaplan-Meier survival estimates and univariate and multivariate Cox proportional hazards regression models, with life expectancies calculated from the models
• Who was studied: 11,487 patients aged 40 or older with microscopically confirmed mesothelioma and known follow-up in the US SEER database, diagnosed 1973 to 2011: 10,258 pleural (89%) and 1,229 peritoneal (11%)
• Exposure: Asbestos exposure was not studied. The factors analyzed in relation to survival were sex, age, race, treatment (radiation only, surgery only, both, or neither), grade, stage (localized, regional, distant), histology (fibrous, epithelial, biphasic, not otherwise specified) and diagnosis year
• Main results:
  • Survival improved only modestly over the study period. Mortality fell about 0.5% per year in pleural cases (hazard ratio 0.995 per year) and roughly 2% per year in peritoneal cases (hazard ratio 0.98 per year), in the multivariate models
  • In the pleural multivariate model, males had a hazard ratio of 1.28 compared with females (28% higher mortality), and mortality rose 2% per year of age. In the peritoneal model, the hazard ratio for males was 1.38
  • Stage had a modest effect in the multivariate models. In pleural cases, distant stage had 1.38 and regional stage 1.36 times the mortality risk of localized stage. In peritoneal cases, the figures were 2.04 for distant and 1.49 for regional
  • Histology: in pleural cases, fibrous type had 58% higher risk (HR 1.58) and biphasic type 43% higher risk (HR 1.43) than epithelial type. In peritoneal cases, fibrous type had an HR of 2.17
  • Patients who received both radiation and surgery had lower risk than those who received neither: HR 0.70 in pleural cases and 0.58 in peritoneal cases. Radiation alone was associated with 22% higher risk in pleural cases. Treatment was not randomized
  • Among males aged 50 to 79 with localized pleural mesothelioma, the observed survival was 46% at one year, 22% at 2 years and 7% at 5 years after diagnosis
  • For a 40-year-old man with distant pleural mesothelioma (white, epithelial type, diagnosed 2010, treated with radiation and surgery), life expectancy was about 4 years at diagnosis, compared with 39 years in the general population. It was 8 years if he survived 2 years (general population 37) and 11 years if he survived 5 years (general population 34)
  • For the most favorable group shown (age 40, localized cancer, radiation and surgery), life expectancy at diagnosis was 11 years for males and 15 for females. In Table 4 these figures are for peritoneal cases; the corresponding pleural figures were 6 and 9 years
• The authors' conclusion: The authors concluded that life expectancy in mesothelioma was much reduced from normal, even among people who survived the first 2 or 5 years after diagnosis, and that survival had not improved in recent decades
• Limitations the authors state:
  • SEER does not record whether patients received chemotherapy
  • Treatment was not randomized, so the treatment results cannot be used as treatment recommendations; treatment may partly reflect patients' health
  • Remission and relapse status after diagnosis are not known, so estimates at 2 and 5 years apply to an 'average' survivor
  • The localized/regional/distant staging system used does not reflect current clinical practice and may be less useful for peritoneal cancers
  • Data on other illnesses (comorbidities such as diabetes or heart disease) were not available
  • Grade was missing in about 90% of cases and was left out of the final models

Topics

Medical terms in this study, explained in our Lexicon: Life Expectancy, Peritoneal Mesothelioma, Mesothelioma, Prognosis, SEER, Histology.

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