Survival patterns for malignant mesothelioma: the SEER experience

Our plain-English summary of Survival patterns for malignant mesothelioma: the SEER experience, by R. Spirtas, R.R. Connelly, M.A. Tucker (International Journal of Cancer, 1988).

The study

• Authors: R. Spirtas, R.R. Connelly, M.A. Tucker
• Journal: International Journal of Cancer
• Published: 1988;41(4):525-30
• Cited by: 112 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000277).

Abstract

Statistical analyses of 1,475 histologically confirmed cases of malignant mesothelioma ascertained through the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute for the years 1973-1984 showed age at diagnosis, sex, stage of disease, type of treatment, and geographic area of residence to be important predictors of patient survival, although type of treatment may be confounded with prognostic factors (patients selected for surgical treatment tended to have better performance status than other patients). Women below the age of 50 had an unusually long survival, even after adjustment for the effects of other variables in the model. A relatively large proportion of female cases had site of disease designated as peritoneum, but site was not a significant prognostic factor. These results suggest that age, gender and stage of disease should be carefully considered in designing and analyzing clinical trials for persons with mesothelioma. Survival was shorter in the 4 SEER registries which had shipbuilding as a major industry than in the others with less potential asbestos exposure, offering weak support for the hypothesis that asbestos-exposed cases of mesothelioma have worse survival experience than other cases.

In plain English

This study used National Cancer Institute SEER cancer registry records to examine survival after a diagnosis of malignant mesothelioma. It included 1,475 cases confirmed by tissue examination during life, diagnosed from 1973 to 1984 in nine US registry areas. Of these, 1,123 were men and 352 were women. Median survival for all cases was 7 months. Survival was shorter with older age, more advanced stage, and no treatment. The authors noted that persons at the most advanced stage were probably too debilitated for treatment, and that treatment was not randomly assigned. Women survived longer than men, and women's survival depended more strongly on age, with women under 50 doing relatively well. The authors found no evidence that site of disease was related to survival for men or women. Cases from four shipbuilding areas, where asbestos exposure was more likely, had significantly shorter average survival. The authors called this weak support for the idea that asbestos-exposed cases survive less long, noting they lacked individual exposure data. The authors concluded that age, stage and sex should be considered in designing future clinical trials.

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: Population-based cancer registry survival analysis (SEER data), using Cox regression and an exponential (Weibull-type) survival model
• Who was studied: 1,638 mesothelioma cases diagnosed 1973-1984 in nine SEER registries (San Francisco-Oakland, Connecticut, Metropolitan Detroit, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Metropolitan Atlanta). These were restricted to 1,475 cases histologically confirmed during life (1,123 male, 352 female). By December 31, 1984, 1,246 had died, 204 were alive and 25 were lost to follow-up.
• Exposure: No individual asbestos exposure data were available. Residence in registry areas with shipbuilding as a major industry (San Francisco, Connecticut, Seattle, Hawaii), where asbestos exposure was considered more likely, was compared with residence in all other registry areas.
• Main results:
  • Median survival for all 1,475 cases combined was 7 months
  • Survival decreased with older age at diagnosis; the youngest age group had the best survival
  • Persons with localized disease had the best prognosis
  • Persons who received no treatment had the worst survival; the authors suggested that persons at the most advanced stage were likely too debilitated for treatment
  • Women had better survival than men, and women's survival varied more with age than men's
  • Women under 50 had relatively better survival than other age-sex groups, for reasons the authors said were unclear
  • Cases from the four shipbuilding areas had significantly shorter average survival than cases from other SEER areas
  • The authors described the shipbuilding-area finding as weak support for the hypothesis that asbestos-exposed cases have poorer survival
  • Men had a higher percentage of pleural cases (87%) than women (63%). The authors found no evidence that site of disease was related to survival for men or women, and site was not a significant prognostic factor.
  • Younger patients at less advanced stages had particularly favorable survival; this age-by-stage effect was marginally significant (p = 0.072)
  • The most common treatments were chemotherapy (26%) and surgery (16%)
• The authors' conclusion: The authors concluded that age, stage of disease and sex should be considered in designing future clinical trials for mesothelioma treatment. They also stated that the study should not be used to suggest approaches to treatment.
• Limitations the authors state:
  • Treatments were not randomly assigned and only initial treatment data were available, so treatments cannot be compared
  • Persons at the most advanced stage of disease were likely too debilitated for treatment, which affects the no-treatment finding
  • Diagnoses could not be verified by an expert panel
  • Staging categories were crude
  • No individual asbestos exposure information was available
  • Misdiagnosis may confound survival measures, especially among women
  • Results may not be directly comparable to those from specialized cancer research centers
  • Histologic subtype was missing for most cases

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, SEER, Epidemiology, Performance Status, Peritoneum, Clinical Trial, Mesothelioma, Asbestos Exposure.

Related studies

• Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival — J.L. Beebe-Dimmer, J.P. Fryzek, et al. (2016)
• Addition of radiotherapy to surgery and chemotherapy improves survival in localized malignant pleural mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) study — A.B. Thompson, T.J. Quinn, et al. (2020)
• Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience — A. Janet-Vendroux, M. Loi, et al. (2015)
• 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)
• Environmental associations and histopathologic patterns of carcinoma of the lung: the challenge and dilemma in epidemiologic studies — J.C. Ives, P.A. Buffler, et al. (1983)
• Trends and geographical patterns of pleural mesotheliomas in the Netherlands 1970-87 — J.M. Meijers, H.T. Planteydt, et al. (1990)

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