Characteristics of malignant pleural mesothelioma in women

Our plain-English summary of Characteristics of malignant pleural mesothelioma in women, by A.S. Wolf, W.G. Richards, T.R. Tilleman, et al (The Annals of Thoracic Surgery, 2010).

The study

• Authors: A.S. Wolf, W.G. Richards, T.R. Tilleman, L. Chirieac, S. Hurwitz, R. Bueno, D.J. Sugarbaker
• Journal: The Annals of Thoracic Surgery
• Published: 2010;90(3):949-56; discussion 956
• Cited by: 50 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The incidence of malignant pleural mesothelioma (MPM) is higher in men than in women, likely due to increased occupational asbestos exposure among men. Women also appear to experience better long-term survival. This study evaluates the role of gender in relation to established prognostic factors in MPM.

Methods: We reviewed 715 cases of MPM treated with extrapleural pneumonectomy at our institution between July 1987 and December 2008. Data for patients with epithelial and nonepithelial tumors were analyzed separately. Kaplan-Meier and Cox regression analyses were used to estimate survival for various cohorts to assess the relationship between gender and survival independent of age at surgery, stage, side, and preoperative laboratory studies.

Results: Of the 702 patients with complete data available, 114 out of 450 patients with epithelial tumors and 31 out of 252 patients with nonepithelial histology were women. Women with epithelial (and not nonepithelial) disease were found to differ significantly from men with respect to younger age, higher rate of thrombocytosis, and longer survival after surgery. The effect of gender on survival of patients with epithelial disease persisted when controlling for age, stage, thrombocytosis, leukocytosis, and anemia with a multivariable analysis. No significant differences in survival were seen among patients with nonepithelial disease with regard to gender, age, or anemia.

Conclusions: In the absence of other negative prognostic factors, women with epithelial MPM demonstrated a survival advantage. These findings support an aggressive approach to treating MPM including extrapleural pneumonectomy in individuals with favorable prognostic predictors, particularly women with epithelial histology and no other risk factors.

2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This was a retrospective review of patients with malignant pleural mesothelioma who had an operation called extrapleural pneumonectomy at Brigham and Women's Hospital in Boston between July 1987 and December 2008. Of 702 patients with complete data, 450 had epithelial tumors (114 of them women) and 252 had nonepithelial tumors (31 of them women). The two tumor groups were analyzed separately. The study did not measure asbestos exposure. Among patients with epithelial tumors, women were younger than men at surgery and more often had high platelet counts. In this group, women survived longer after surgery. After taking stage, age and blood test results into account, the hazard ratio for death for women was 0.75 (95% confidence interval 0.58 to 0.95). Among patients with nonepithelial tumors, gender was not an independent predictor of survival. The authors concluded that their findings support an aggressive treatment approach that includes this surgery for patients with favorable prognostic factors, particularly women with epithelial tumors and no other risk factors. They noted that the study was retrospective and lacked data on treatment given after surgery.

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 a single institution's patient registry (survival analysis using Kaplan-Meier and Cox regression)
• Who was studied: 715 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy at Brigham and Women's Hospital, Boston, between July 1987 and December 2008. After exclusions for missing data, 702 were analyzed: 450 with epithelial tumors (114 women, 25%) and 252 with nonepithelial tumors (31 women, 12%).
• Exposure: Asbestos exposure was not measured. The factor studied was gender, examined together with other prognostic factors: age, stage, side of disease, and preoperative blood counts (anemia, leukocytosis, thrombocytosis). All patients had the same surgery.
• Main results:
  • Epithelial tumors, univariate analysis: women had a hazard ratio for death of 0.681 (95% CI 0.538 to 0.862, p 0.0014). Nonepithelial tumors: hazard ratio for women 0.886 (95% CI 0.584 to 1.343, p 0.5678).
  • Epithelial tumors, multivariable analysis: the adjusted hazard ratio for female gender was 0.75 (95% CI 0.58 to 0.95, p 0.017). Male gender, advanced stage, age 50 or older, thrombocytosis, anemia and leukocytosis were independent predictors of poor survival.
  • Nonepithelial tumors: female gender was not an independent predictor of longer survival. Only stage, leukocytosis and thrombocytosis were independent predictors.
  • Epithelial tumors: women were younger at surgery than men (median 56 vs 60 years, p 0.0013), and more often had thrombocytosis (30% vs 21%). Anemia was more common in men in both tumor groups.
  • Epithelial tumors: advanced stage was associated with a 140% increase in the risk of death for women, compared with a 70% increase for men.
  • Perioperative mortality, epithelial tumors: 1.8% (2 of 114) for women vs 6.3% (21 of 336) for men (p 0.0820). Nonepithelial tumors: 3.2% (1 of 31) for women vs 4.5% (10 of 221) for men.
  • Women with epithelial tumors: the major in-hospital morbidity rate was 34.8% (39 of 112).
• The authors' conclusion: The authors concluded that women with epithelial malignant pleural mesothelioma and no other negative prognostic factors had a survival advantage. In their view, this supports an aggressive treatment approach, including extrapleural pneumonectomy, for patients with good prognostic predictors, particularly women with epithelial histology and no other risk factors.
• Limitations the authors state:
  • The study was retrospective, so covariates such as adjuvant therapy (treatment after surgery) could not be included in the multivariable analysis.
  • There were too few women to detect a statistically significant age-related survival difference among women with epithelial tumors.
  • Data on menopausal status were not available for individual patients.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Extrapleural Pneumonectomy (EPP), Histology.

Related studies

• Women with malignant pleural mesothelioma have a threefold better survival rate than men — E. Taioli, A.S. Wolf, et al. (2014)
• Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy — D.J. Sugarbaker, A.S. Wolf, et al. (2011)
• Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma — L.R. Chirieac, J.A. Barletta, et al. (2013)
• Clinicopathologic and genetic characteristics of young patients with pleural diffuse malignant mesothelioma — M. Vivero, R. Bueno, et al. (2018)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients — D.J. Sugarbaker, W.G. Richards, et al. (2014)

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