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. 2015 Jun 1;196(1):23-32.
doi: 10.1016/j.jss.2015.01.043. Epub 2015 Jan 29.

Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database

Robert Ryan Meyerhoff  1 , Chi-Fu Jeffrey Yang  2 , Paul J Speicher  2 , Brian C Gulack  2 , Matthew G Hartwig  2 , Thomas A D'Amico  2 , David H Harpole  2 , Mark F Berry  3
Affiliations

Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database

Robert Ryan Meyerhoff et al. J Surg Res. .

Abstract

Background: This study was conducted to determine how malignant pleural mesothelioma (MPM) histology was associated with the use of surgery and survival.

Methods: Overall survival of patients with stage I-III epithelioid, sarcomatoid, and biphasic MPM in the Surveillance, Epidemiology, and End Results database from 2004-2010 was evaluated using multivariate Cox proportional hazards models.

Results: Of 1183 patients who met inclusion criteria, histologic subtype was epithelioid in 811 patients (69%), biphasic in 148 patients (12%), and sarcomatoid in 224 patients (19%). Median survival was 14 mo in the epithelioid group, 10 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). Cancer-directed surgery was used more often in patients with epithelioid (37%, 299/811) and biphasic (44%, 65/148) histologies as compared with patients with sarcomatoid histology (26%, 58/224; P < 0.01). Among patients who underwent surgery, median survival was 19 mo in the epithelioid group, 12 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). In multivariate analysis, surgery was associated with improved survival in the epithelioid group (hazard ratio [HR] 0.72; P < 0.01) but not in biphasic (HR 0.73; P = 0.19) or sarcomatoid (HR 0.79; P = 0.18) groups.

Conclusions: Cancer-directed surgery is associated with significantly improved survival for MPM patients with epithelioid histology, but patients with sarcomatoid and biphasic histologies have poor prognoses that may not be favored by operative treatment. The specific histology should be identified before treatment, so that surgery can be offered to patients with epithelioid histology, as these patients are most likely to benefit.

Keywords: Biphasic; Epithelioid; Fibrous; Mesothelioma; SEER; Sarcomatoid; Surgery.

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Figures

Fig. 1
Fig. 1. Sample inclusion and exclusion selection criteria
Fig. 2
Fig. 2. Unadjusted Kaplan–Meier survival for patients with MPM, stratified by histologic subtype
Fig. 3
Fig. 3. Unadjusted Kaplan–Meier overall survival by best staging for patients with epithelioid (A), sarcomatoid (B), and biphasic (C) subtype MPM
Fig. 4
Fig. 4. Unadjusted Kaplan–Meier overall survival for patients receiving cancer-directed surgery versus no surgery for epithelioid (A), sarcomatoid (B), and biphasic (C) subtype MPM
See this image and copyright information in PMC

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