National Trends in the Epidemiology of Malignant Pleural Mesothelioma: A National Cancer Data Base Study

Our plain-English summary of National Trends in the Epidemiology of Malignant Pleural Mesothelioma: A National Cancer Data Base Study, by S.A. Saddoughi, Z.M. Abdelsattar, S.H. Blackmon (The Annals of Thoracic Surgery, 2018).

The study

• Authors: S.A. Saddoughi, Z.M. Abdelsattar, S.H. Blackmon
• Journal: The Annals of Thoracic Surgery
• Published: 2018;105(2):432-437
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) remains an aggressive malignancy that is difficult to cure. However, the treatment paradigm of MPM has evolved, and the national practice patterns are unknown. This study examined the national trends in the epidemiology, national treatment patterns, and survival of patients with this disease.

Methods: We identified all patients (n = 19,134) with MPM from the National Cancer Data Base from 2004 to 2013. We analyzed patient, tumor characteristics, and treatment patterns using descriptive statistics and used Kaplan-Meier and Cox proportional hazards models to estimate survival stratified by the type of therapy administered.

Results: Four histologic subtypes were represented in the National Cancer Data Base, these included sarcomatoid (n = 2,355 [12.3%]), epithelioid (n = 6,858 [35.8%]), biphasic (n = 13,617 [11%]), and not otherwise specified (n = 8,560 [44.7%]). Across all subtypes, the prevalence of mesothelioma was highest among white men. Sarcomatoid had the worst survival (adjusted hazard ratio, 2.2; p < 0.001). Most patients did not receive any specific modality of treatment (40.2%). Chemotherapy alone was the most common treatment used (31.8%). Trimodality treatment with chemotherapy, surgical resection, and radiation therapy was associated with the best survival (adjusted hazard ratio, 0.43; p < 0.001), followed by combination chemotherapy and resection (adjusted hazard ratio, 0.49; p < 0.001).

Conclusions: This is the first publication to date to analyze the mesothelioma National Cancer Data Base. Although survival remains poor, multimodality therapy with surgical resection is associated with the best survival for MPM. Further research is needed to improve survival and overall patient outcomes.

Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This retrospective study used the National Cancer Data Base, a United States cancer registry. The authors analyzed 19,134 adults diagnosed with malignant pleural mesothelioma (mesothelioma of the lining around the lungs) from 2004 to 2013. They examined patient characteristics, tumor subtype, treatment and survival. The study did not examine asbestos exposure. Most patients were men (76.1% to 87.4%, depending on subtype) and white. Compared with the epithelioid subtype, the sarcomatoid subtype was associated with a higher risk of death (adjusted hazard ratio 2.20, 95% confidence interval 2.06 to 2.35). About 40% of patients received no chemotherapy, radiation or surgery, and chemotherapy alone was the most common treatment. Compared with no treatment, combined chemotherapy, surgery and radiation was associated with the lowest risk of death (adjusted hazard ratio 0.43, 95% confidence interval 0.39 to 0.48). Median survival was 19.9 months with this combination versus 4.8 months without therapy. The authors concluded that this three-part treatment is underused yet provides the best overall survival. They noted the database lacks chemotherapy details, type of surgery and cause of death.

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 national cancer registry (National Cancer Data Base), comparing survival by tumor subtype and treatment type
• Who was studied: 19,134 adults (over 18) diagnosed with malignant pleural mesothelioma from 2004 to 2013, recorded in the National Cancer Data Base, which draws on more than 1,500 accredited US cancer centers
• Exposure: No asbestos exposure was studied. The factors compared were tumor histologic subtype (epithelioid, sarcomatoid, biphasic, not otherwise specified) and type of treatment (chemotherapy, radiation therapy, surgical resection, or combinations), along with demographic factors
• Main results:
  • Among all 19,134 cases, subtypes were: not otherwise specified 44.7%, epithelioid 35.8%, sarcomatoid 12.3%, biphasic 7.11%
  • Depending on subtype, 76.1% to 87.4% of patients were men and 91.9% to 95% were white
  • Epithelioid cases rose from 510 in 2004 to 851 in 2013
  • Compared with epithelioid histology, sarcomatoid histology was associated with worse survival (adjusted hazard ratio 2.20, 95% CI 2.06 to 2.35)
  • The text reports that 40% of patients received no treatment (chemotherapy, radiation therapy or surgical resection)
  • Chemotherapy alone was given to 31% of patients
  • Compared with no therapy, chemotherapy plus resection plus radiation therapy (trimodality) was associated with an adjusted hazard ratio for death of 0.43 (95% CI 0.39 to 0.48)
  • Compared with no therapy, chemotherapy plus resection was associated with an adjusted hazard ratio of 0.49 (95% CI 0.46 to 0.52)
  • Compared with no therapy, chemotherapy alone was associated with an adjusted hazard ratio of 0.61 (95% CI 0.58 to 0.64), and resection alone with 0.70 (95% CI 0.65 to 0.76)
  • Median survival was 4.8 months for patients with no therapy and 19.9 months for patients with trimodality therapy
  • Median survival with chemotherapy combined with surgery was 15.3 months
  • Male sex was associated with worse survival (adjusted hazard ratio 1.24, 95% CI 1.18 to 1.30)
• The authors' conclusion: The authors concluded that trimodality treatment is underused yet provides the best overall survival, and that, although survival remains poor, multimodality therapy with surgical resection is associated with the best survival
• Limitations the authors state:
  • The data come from a retrospective database that captures an estimated 70% of US cancer cases
  • The type and dose of chemotherapy are not available in the database
  • The database does not record the type, approach, timing or completeness of surgery, so the kind of operation cannot be determined
  • Only overall survival could be reported. There was no cause of death or tumor progression or recurrence data

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Pleural Mesothelioma, Histological Subtype, Sarcomatoid, Epithelioid, Biphasic Mesothelioma, Mesothelioma, Hazard Ratio.

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