arcinogenesis. 2019 Jan 10. doi: 10.1093/carcin/bgz004. [Epub ahead of print]

Prognostic Factors of Survival in Patients with Malignant Pleural Mesothelioma; an analysis of the National Cancer Data Base.

van Gerwen M1, Alpert N1, Wolf A2, Ohri N3, Lewis E2, Rosenzweig KE4, Flores R2,5, Taioli E1,2,5.

Author information

1

Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.

2

Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, USA.

3

Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA.

4

Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, USA.

5

Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA.

Abstract

Malignant pleural mesothelioma is a rare disease with a very poor prognosis. Previous studies have indicated that women experience longer survival compared to men. We analyzed 16,267 eligible patients (21.3% females) in the National Cancer Data Base to evaluate which clinical factors are independently predictive of longer survival. After adjusting for all covariates, survival was significantly better in females compared to males (HRadj: 0.81, 95% CI: 0.77-0.85). Other factors significantly associated with better survival were younger age at diagnosis, higher income, lower comorbidity score, epithelial histology, earlier stage, and receipt of surgical or medical treatment. After propensity matching, survival was significantly better for females compared to males (HR: 0.86, 95% CI: 0.80-0.94). After propensity matching within the epithelial group, survival remained significantly better for females compared to males (HR: 0.85, 95% CI: 0.74-0.97). This study adds information to the known significant gender survival difference in MPM by disentangling the effect of gender from the effect of age and histology, two known independent factors affecting survival. Circulating estrogen, present in young but not older women, and higher expression of the estrogen receptor beta in epithelial mesothelioma have been suggested to play a role in gender survival differences. These findings may lead to exploring new therapeutic options such as targeting estrogen receptor beta, and considering hormonal therapy including estrogens for patients with otherwise limited prognosis.