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. 2015 Feb;8(1):35-9.
doi: 10.1016/j.tranon.2014.12.002.

Changing pattern in malignant mesothelioma survival

Jennifer Faig  1 , Suzanne Howard  2 , Edward A Levine  3 , Gary Casselman  4 , Mary Hesdorffer  5 , Jill A Ohar  6
Affiliations

Changing pattern in malignant mesothelioma survival

Jennifer Faig et al. Transl Oncol. 2015 Feb.

Abstract

Survival for mesothelioma has been shown to be poor, with marginal improvement over time. Recent advances in the understanding of pathophysiology and treatment of mesothelioma may impact therapy to improve survival that may not be evident from available clinical trials that are often small and not randomized. Therapies may affect survival differently based on mesothelioma location (pleural vs peritoneal). Data are conflicting regarding the effect of asbestos exposure on mesothelioma location.

Objectives: We examined survival in a large cohort of mesothelioma subjects analyzed by tumor location and presence and mode of asbestos exposure.

Methods: Data were analyzed from cases (n = 380) diagnosed with mesothelioma from 1992 to 2012. Cases were either drawn from treatment referrals, independent medical evaluation for medical legal purposes, or volunteers who were diagnosed with mesothelioma. Subjects completed an occupational medical questionnaire, personal interview with the examining physician, and physician review of the medical record.

Results: This study reports better survival for mesothelioma than historical reports. Survival for peritoneal mesothelioma was longer than that for pleural mesothelioma (hazard ratio = 0.36, 95% confidence interval = 0.24-0.54, P < .001) after adjusting for gender and age at diagnosis. Non-occupational cases were more likely to be 1) diagnosed with peritoneal mesothelioma, 2) female, 3) exposed, and 4) diagnosed at a younger age and to have a 5) shorter latency compared to occupational cases (P < .001).

Conclusion: Peritoneal mesothelioma was more likely associated with non-occupational exposure, thus emphasizing the importance of exposure history in enhancing early diagnosis and treatment impact.

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Figures

Figure 1
Figure 1
Mesothelioma survival by location. Kaplan-Meier curve representing survival in months from diagnosis of peritoneal versus pleural mesothelioma cases. There was a significant difference in survival between groups, with peritoneal mesothelioma patients having a more favorable survival outcome compared to pleural cases (log-rank P < .001). Peritoneal mesothelioma survival and pleural mesothelioma survival are shown as solid and dashed lines, respectively.
Figure 2
Figure 2
Anatomic location of mesothelioma with regard to exposure type. A total of 380 patients were enrolled in the study. There were 284 patients exposed to asbestos in an occupational setting: 257 (90.5%) developed pleural mesothelioma and 27 (9.5%) developed peritoneal mesothelioma. There were 96 patients exposed to asbestos in the non-occupational setting: 46 (47.9%) developed pleural mesothelioma and 50 (52.1%) developed peritoneal mesothelioma.
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