Abstract
Although considered a disease of the elderly, a subset of patients with mesothelioma are young (<40 years). The goal of this study was to understand their characteristics and outcomes. The Surveillance, Epidemiology, and End Results (SEER) database was used to extract mesothelioma cases (1990-2010). We modeled Kaplan-Meyer survival curves stratified by site of disease, and age of presentation. 2% (207 of 12345) of mesothelioma patients are young. Sex distribution is comparable among the young (51% males, 49% females); males predominated (78%, 22%) in the older cohort. Frequency of pleural and peritoneal mesothelioma are similar in the young (47%, 48% respectively); pleural disease predominated in the old (90%, 9%). Cancer-directed surgeries are more frequent in the young. Regardless of histologic subtype, young patients with pleural (11 vs. 8 months) and peritoneal (not reached vs. 10 months) mesothelioma had significantly improved overall survival. In multivariate analysis, younger age was an independent prognostic factor. Although rare, mesothelioma do occur in the young; their characteristics are distinct from those of older patients. Further studies are needed to understand the interplay between genetic susceptibility and mineral fiber carcinogenesis in the pathogenesis of mesothelioma in the young.
Highlights
Malignant Mesothelioma is an invasive and often fatal neoplasm that arises from mesothelium that lines several organs
For patients with unresectable disease, chemotherapy using the regimen of cisplatin plus pemetrexed is the standard of care [2]
This study provides a comprehensive description of mesothelioma in the young including frequency, timetrends, treatments, outcomes and prognostic factors
Summary
Malignant Mesothelioma is an invasive and often fatal neoplasm that arises from mesothelium that lines several organs. Common primary sites of origin of mesothelioma are the pleura (80–90%) and peritoneum (10–15%) and rarely the pericardium and tunica vaginalis [1]. Among the three main histologic subtypes of mesothelioma, epithelioid tumors are the most common and have a better prognosis than biphasic and sarcomatoid tumors. In patients for whom a macroscopic complete resection is thought to be feasible, mesothelioma is managed with surgery, usually in combination with other modalities of treatment such as chemotherapy or radiation. For patients with unresectable disease, chemotherapy using the regimen of cisplatin plus pemetrexed is the standard of care [2]. The prognosis of patients with unresectable disease is poor with median survival ranging from 10-13 months [2,3,4]
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