Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma

Our plain-English summary of Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma, by E. Taioli, A.S. Wolf, J.M. Moline, et al (Disease Markers, 2015).

The study

• Authors: E. Taioli, A.S. Wolf, J.M. Moline, M. Camacho-Rivera, R.M. Flores
• Journal: Disease Markers
• Published: 2015;2015:282145
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival.

Methods: All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white).

Results: There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted, p = 0.01). Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancer-directed surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77-0.88)) and early stage at diagnosis (HR 0.83 (0.76-0.90)) were predictive of longer survival in white, but not in black, patients.

Conclusions: Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.

In plain English

This study used the US SEER cancer registry, 1973 to 2009, to compare black and white patients with malignant pleural mesothelioma (MPM), which the authors describe as an asbestos-related cancer. It included 13,046 white and 688 black patients with a pathologically confirmed diagnosis. Asbestos exposure was not measured. Age-adjusted incidence was 1.1 per 100,000 in whites and 0.5 per 100,000 in blacks. Black patients were more often female (26% versus 22%), younger, and diagnosed at distant stage (65% versus 59%). Fewer black than white patients had cancer-directed surgery (18% versus 24%), and black patients had lower surgery rates within each stage group. Overall survival was similar in the two groups. In adjusted analyses, younger age and surgery were associated with longer survival in both groups. Female sex and stage predicted survival in white but not black patients. The authors concluded that black patients received surgery less often at every stage yet had similar survival, and that their access to treatment needs further study. The authors could not analyze which surgical approach was performed, and SEER held no chemotherapy information.

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 US population-based cancer registry (SEER database), comparing black and white patients
• Who was studied: 13,046 white and 688 black adult patients with pathologically diagnosed malignant pleural mesothelioma in the US SEER registries, 1973 to 2009. Patients under 18, post-mortem cases, cases without microscopic confirmation, and mesotheliomas of other sites (including peritoneal) were excluded.
• Exposure: Self-reported race (black or white) and treatment received (cancer-directed surgery, radiation). Asbestos exposure, fiber types and occupations were not measured. Chemotherapy data were not available.
• Main results:
  • Age-adjusted MPM incidence was 1.1 per 100,000 in whites and 0.5 per 100,000 in blacks (p = 0.01).
  • Compared with white patients, black patients were more likely to be female (26% versus 22%), younger (mean age 66.6 versus 70.2 years), and diagnosed at distant stage (65% versus 59%).
  • Black patients were less likely than white patients to receive cancer-directed surgery (18%, 125 of 688, versus 24%, 3,087 of 13,046). More black patients received neither surgery nor radiation (73% versus 68%).
  • Within each stage group, a smaller share of black than white patients had surgery. For localized disease the figures were 29.3% of black and 31.5% of white patients; for distant disease, 15.1% of black and 21.4% of white patients.
  • Overall survival was similar for black and white patients. Mean survival was 15.5 months in whites and 16.7 months in blacks (p = 0.899).
  • In multivariable analysis, younger age and cancer-directed surgery were associated with longer survival in both groups. The adjusted hazard ratio for surgery was 0.65 (95% CI 0.61 to 0.70) in whites and 0.53 (0.38 to 0.73) in blacks. Female gender and early stage predicted longer survival only in white patients. For sex, the hazard ratio was 0.82 (0.77 to 0.88) in whites and 1.10 (0.84 to 1.44) in blacks.
  • Among patients who received no treatment, 3-year and 5-year survival were 7.9% and 3.5% in whites, and 10.6% and 6.7% in blacks.
• The authors' conclusion: The authors concluded that black MPM patients were treated with surgery less often than white patients at every stage, yet had similar survival. They called for further study of whether better access to the same treatments would improve survival in black patients.
• Limitations the authors state:
  • The authors could not analyze which surgical approach was performed (extrapleural pneumonectomy or radical pleurectomy/decortication), nor whether it differed by race.
  • SEER contains no information on chemotherapy.
  • Stage was broadly defined and histology classification was of limited quality.
  • Possible reasons for later-stage diagnosis in black patients, such as access to care or insurance, could not be examined because SEER lacks this information.

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, Epidemiology, SEER.

Related studies

• Frequency of use and predictors of cancer-directed surgery in the management of malignant pleural mesothelioma in a community-based (Surveillance, Epidemiology, and End Results [SEER]) population — R.M. Flores, E. Riedel, et al. (2010)
• Lung cancer risk and workplace exposures in black men and women — J.E. Muscat, S.D. Stellman, et al. (1998)
• Surgery for malignant pleural mesothelioma — D.J. Sugarbaker, A.S. Wolf (2010)
• The mesothelioma surgery shift — R.M. Flores (2016)
• Ethnic differences in lung function: evidence for proportional differences — C.E. Rossiter, H. Weill (1974)
• Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients — P. Bovolato, C. Casadio, et al. (2014)

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