Gender Differences in Outcomes of Patients With Mesothelioma

Our plain-English summary of Gender Differences in Outcomes of Patients With Mesothelioma, by N. Alpert, M. van Gerwen, R. Flores, et al (American Journal of Clinical Oncology, 2020).

The study

• Authors: N. Alpert, M. van Gerwen, R. Flores, E. Taioli
• Journal: American Journal of Clinical Oncology
• Published: 2020;43(11):792-797
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare and deadly form of cancer, linked to asbestos exposure. Although the United Kingdom has banned asbestos, the incidence rate remains high. Previous research has indicated that female individuals have better survival than male individuals, but this has never been examined in the United Kingdom.

Materials And Methods: Pleural mesothelioma cases from 2005 to 2014 were extracted from the United Kingdom Lung Cancer Dataset. Multivariable logistic regression was used to assess the clinical and demographic factors associated with gender. A multivariable Cox proportional hazards model and propensity matching methods were used to assess gender differences in overall survival while accounting for potential confounders.

Results: There were 8479 (87.8%) male and 1765 (17.2%) female individuals included in the analysis. Female individuals were significantly younger, with more epithelial histology than male individuals. Female individuals had significantly better overall survival (adjusted hazard ratio, 0.85, 95% confidence interval, 0.81-0.90). Results remained similar when stratifying by age and performance status, and when limiting to patients with epithelial histology.

Conclusions: The study increases knowledge about gender differences in mesothelioma survival and is the first to directly examine this in the United Kingdom. It further disentangles the effects of age, histology, and health status. Increased estrogen may improve survival and could provide a potential target for future therapies.

In plain English

This study used a national lung cancer database, the National Lung Cancer Audit's LUCADA dataset, to compare survival between men and women with pleural mesothelioma diagnosed in England from 2005 to 2014. There were 10,244 patients: 8479 men and 1765 women. The dataset had no detailed occupational history, so asbestos exposure was not studied. Women were somewhat younger and more often had the epithelial tumor type. At 2 years, 21.7% of women (95% confidence interval 19.7%-23.7%) and 16.3% of men (15.5%-17.1%) were alive. After adjusting for age, tumor type, health status, treatment and other factors, women had a lower risk of death (adjusted hazard ratio 0.85, 95% confidence interval 0.81-0.90). Women also had better survival in matched comparisons, including among patients with epithelial tumors. Among patients in poorer health (ECOG score 2 or 3), the difference was not statistically significant. The authors concluded that women's better survival was not entirely explained by age and tumor characteristics. They noted that cancer stage was recorded for less than 30% of patients and that about 40% of cases had codes that did not specify a pleural site.

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 national cancer audit data (LUCADA), using multivariable Cox proportional hazards models and propensity score matching to compare survival by gender
• Who was studied: Patients with mesothelioma diagnosed in England from 2005 to 2014 in the National Lung Cancer Audit LUCADA dataset. 10,357 were identified and 113 with an unknown diagnosis date were excluded, leaving 10,244 (8479 men, 1765 women). About 40% had codes that did not specify a pleural site; the authors assumed these were mostly pleural.
• Exposure: The factor studied was patient gender. Asbestos exposure was not measured: the dataset had no detailed occupational history.
• Main results:
  • The sample was 8479 men (82.8%) and 1765 women (17.2%).
  • Women were significantly younger than men (22.1% of women vs 19.7% of men under 65) and more often had epithelial histology (35.7% vs 30.9%).
  • Survival at 2 years was 21.7% (95% CI 19.7%-23.7%) for women and 16.3% (15.5%-17.1%) for men. At 5 years it was 5.7% for women and 3.7% for men.
  • After adjusting for all covariates, women had better survival than men (adjusted hazard ratio 0.85; 95% CI 0.81-0.90).
  • In the propensity-matched cohort of 3110 patients, women had better survival than men at 2 years (22.2% vs 16.9%) and 5 years (5.1% vs 3.7%) (HR 0.89; 95% CI 0.82-0.96).
  • In matched patients, women had better survival both under age 65 (HR 0.77; 95% CI 0.65-0.90) and at age 65 and over (HR 0.90; 95% CI 0.82-0.97).
  • Among 1094 matched patients with epithelial histology, women had better survival (HR 0.79; 95% CI 0.69-0.90).
  • Among matched patients with ECOG performance status 0 or 1, women had better survival (HR 0.81; 95% CI 0.73-0.90).
  • Among matched patients with ECOG status 2 or 3, survival was not significantly different by sex, though it trended toward better survival for women (HR 0.89; 95% CI 0.77-1.03).
• The authors' conclusion: The authors concluded that women with pleural mesothelioma in this dataset had better survival than men, and that this was not entirely explained by women's more favorable age and tumor characteristics.
• Limitations the authors state:
  • Cancer stage was recorded for less than 30% of patients and could not be included in the models.
  • About 40% of the cohort had diagnostic codes that did not specify whether the cancer was pleural.
  • Many patients lacked detailed information on histologic subtype.
  • The dataset had no detailed occupational history, so asbestos exposure could not be taken into account.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Incidence, Pleural Mesothelioma, Lung Cancer, Overall Survival, Histology, Hazard Ratio.

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• Gender differences in murine pulmonary responses elicited by cellulose nanocrystals — A.A. Shvedova, E.R. Kisin, et al. (2016)
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• Gender differences in pleural mesothelioma occurrence in Lombardy and Piedmont, Italy — D. Consonni, E. Migliore, et al. (2019)
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