Abstract
Background: Malignant mesothelioma (MM) is a rare but deadly malignancy with about 3,000 new cases being diagnosed each year in the US. Very few studies have been performed to analyze factors associated with mesothelioma survival, especially for peritoneal presentation. The overarching aim of this study is to examine survival of the cohort of patients with malignant mesothelioma enrolled in the National Mesothelioma Virtual Bank (NMVB). Methods: 888 cases of pleural and peritoneal mesothelioma cases were selected from the NMVB database, which houses over 1400 cases that were diagnosed from 1990 to 2017. Kaplan Meier's method was performed for survival analysis. The association between prognostic factors and survival was estimated using Cox Hazard Regression method and using R software for analysis. Results: The median overall survival (OS) rate of all MM patients, including pleural and peritoneal mesothelioma cases is 15 months (14 months for pleural and 31 months for peritoneal). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were below the age of 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and had treatment that consisted of combining surgical therapy with chemotherapy. Combined surgical and chemotherapy treatment was associated with improved survival of 23 months in comparison to single line therapies. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with current available treatment options. Our findings show that combined surgical and chemotherapy treatment in peritoneal mesothelioma is associated with improved survival compared to local therapy alone.
Highlights
Malignant mesothelioma is a rare and fatal malignancy, associated with occupational and environmental exposure to asbestos
Cancer directed surgery has been performed in 54 % cases, while surgery and chemotherapy treatment jointly has been administered in 37% of cases
The focus of this study has been on the exploration of risk factors affecting mortality in the states of Pennsylvania and New York, a region with an aging population, environmental concerns, history of notable asbestos exposure, and other risk factors associated with mesothelioma development
Summary
Malignant mesothelioma is a rare and fatal malignancy, associated with occupational and environmental exposure to asbestos. In the 1970s, the incidence of mesothelioma cases started to increase, and it became evident that the occupational and environmental exposures to asbestos (occurring during 1930s– 1970s) were associated with the increased incidence of this fatal disease. Mesotheliomas develops in carriers of germline mutations of BAP1 (Carbone M., Kanodia S., JTO 20166, and mutations of BAP1 may increase susceptibility to low doses of asbestos and other mineral fibers (Napolitano A., Pellegrini L., et al). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were below the age of 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and had treatment that consisted of combining surgical therapy with chemotherapy. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with version 3 (revision)
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