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Review
. 2023 Jun;12(11):12208-12220.
doi: 10.1002/cam4.5915. Epub 2023 Apr 16.

Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database

Patrick Bou-Samra  1   2 , Austin Chang  1   2 , Feredun Azari  1   2 , Gregory Kennedy  1   2 , Alix Segil  1   2 , Emily Guo  1   2 , Melina Marmarelis  1   3 , Corey Langer  1   3 , Sunil Singhal  1   2
Affiliations
Review

Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database

Patrick Bou-Samra et al. Cancer Med. 2023 Jun.

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive cancer of the cells lining the pleural cavity with a low overall incidence. The National Cancer Database (NCDB) released in August 2022 updated data that reflect the newest trends in MPM.

Methods: The NCDB was queried for patients diagnosed with MPM between 2004 and 2020. Variables collected included demographics, tumor characteristics, and treatment. Student's t-test and independent-samples proportions test were used for means analysis. Survival was assessed by the Kaplan-Meier method using SPSS version 28.

Results: A total of 41,074 patients were diagnosed with mesothelioma, with a steady incidence (0.25%) between 2004 and 2017. The mean age of diagnosis was 70 (SD 13). 73.2% of the patients were males, 69% had no comorbidities, and 93.3% were white. More patients were diagnosed at Stage 1 after 2008 (p < 0.001). Since 2010, there has been a significant increase in patients offered treatment with 73.9% receiving some therapy (p < 0.01): 50.5% received chemotherapy, 27.6% surgery, 8.6% radiation, and 5.4% immunotherapy. The median overall survival was 10.3 months from diagnosis [95% CI: 10.2-10.5]. Risk factors associated with 30-day mortality from surgical intervention included age (OR = 1.02, p < 0.001), male gender (OR = 1.3, p = 0.03), poorly differentiated grade (OR = 2.1, p < 0.001), Stage 4 (OR = 1.4, p = 0014), and epithelioid histology (OR = 0.51, p = 0.03).

Conclusion: The current management of MPM is based on stage and histologic subtype. Due to the small numbers of patients at most academic centers, the NCDB provides a robust dataset to draw upon broad data points in treatment discussions with patients.

Keywords: incidence; malignant mesothelioma; risk factors; treatment.

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Conflict of interest statement

There are no conflicts of interest or financial disclosures for any of the authors listed above.

Figures

FIGURE 1
FIGURE 1
Incidence of mesothelioma between 2004 and 2017.
FIGURE 2
FIGURE 2
(A) Patient distribution according to AJCC Clinical Stage group. (B) Distribution of mesothelioma staging divided between Stage 1 and other stages between 2004 and 2020. (C) Percentage of patients without a specified histology based on year of diagnosis.
FIGURE 3
FIGURE 3
Survival curves based on surgery status (A). Survival curves among those who underwent surgery stratified by stage (B) or histologic subtype (C).
FIGURE 4
FIGURE 4
Survival curves based on chemotherapy status (A). Survival curves among those who received chemotherapy stratified by stage (B) or histologic subtype (C).
FIGURE 5
FIGURE 5
Survival curves based on immunotherapy status (A). Survival curves among those who underwent immunotherapy stratified by stage (B) or histologic subtype (C).
FIGURE 6
FIGURE 6
Survival curves based on radiotherapy status (A). Survival curves among those who underwent radiotherapy stratified by stage (B) or histologic subtype (C).
See this image and copyright information in PMC

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