Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec 14;10(12):e0145039.
doi: 10.1371/journal.pone.0145039. eCollection 2015.

Determinants of Survival in Malignant Pleural Mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) Study of 14,228 Patients

Emanuela Taioli  1   2 , Andrea S Wolf  1 , Marlene Camacho-Rivera  3 , Andrew Kaufman  1 , Dong-Seok Lee  1 , Daniel Nicastri  1 , Kenneth Rosenzweig  4 , Raja M Flores  1
Affiliations

Determinants of Survival in Malignant Pleural Mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) Study of 14,228 Patients

Emanuela Taioli et al. PLoS One. .

Abstract

Introduction: Left untreated, malignant pleural mesothelioma (MPM) is associated with uniformly poor prognosis. Better survival has been reported with surgery-based multimodality therapy, but to date, no trial has demonstrated survival benefit of surgery over other therapies. We evaluated whether cancer-directed surgery influenced survival independently from other predictors in a large population-based dataset.

Methods: The SEER database was explored from 1973 to 2009 to identify all cases of pathologically-proven MPM. Age, sex, race, year of diagnosis, histology stage, cancer-directed surgery, radiation, and vital status were analyzed. The association between prognostic factors and survival was estimated using Cox regression and propensity matched analysis.

Results: There were 14,228 patients with pathologic diagnosis of MPM. On multivariable analysis, female gender, younger age, early stage, and treatment with surgery were independent predictors of longer survival. In comparison to no treatment, surgery alone was associated with significant improvement in survival [adjusted hazard ratio (adj HR) 0.64 (0.61-0.67)], but not radiation [adj HR 1.15 (1.08-1.23)]. Surgery and radiation combined had similar survival as surgery alone [adj HR 0.69 (0.64-0.76)]. Results were similar when cases diagnosed between 1973 and 1999 were compared to cases diagnosed between 2000 and 2009.

Conclusions: Despite developments in surgical and radiation techniques, the prognosis for MPM patients has not improved over the past 4 decades. Cancer-directed surgery is independently associated with better survival, suggesting that multimodal surgery-based therapy can benefit these patients. Further research in adjuvant treatment is necessary to improve prognosis in this challenging disease.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival according to type of treatment (SEER database).
See this image and copyright information in PMC

References

    1. Price B, Ware A. Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005. Critical Rev. Toxicol. 2009; 39: 576–588. - PubMed
    1. Taioli E, Wolf AS, Flores RM. Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma. Ann. Thorac. Surg. 2015; 99(2):472–80 10.1016/j.athoracsur.2014.09.056 - DOI - PubMed
    1. Treasure T, Lang-Lazdunski L, Waller D, Bliss JM, Tan C, Entwisle J, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomized feasibility study. The Lancet Oncology 2011; 12: 763–772 10.1016/S1470-2045(11)70149-8 - DOI - PMC - PubMed
    1. Bovolato P, Casadio C, Billè A, Ardissone F, Santambrogio L, Ratto GB, et al. Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients. J. Thorac. Oncol. 2014; 9(3):390–6. 10.1097/JTO.0000000000000064 - DOI - PubMed
    1. Kapeles M, Gensheimer MF, Mart DA, Sottero TL, Kusano AS, Truong A, et al. Trimodality Treatment of Malignant Pleural Mesothelioma: An Institutional Review. Am. J. Clin. Oncol. 2015. August 27 [Epub ahead of print] - PubMed

MeSH terms