title: Asbestos exposure and survival in malignant mesothelioma: a description of 122 consecutive cases at an occupational clinic.
abstract: BACKGROUND
  The natural history and etiology of malignant mesothelioma (MM) is already thoroughly described in the literature, but there is still debate on prognostic factors, and details of asbestos exposure and possible context with clinical and demographic data, have not been investigated comprehensively.
  
  
  OBJECTIVE
  Description of patients with MM, focusing on exposure, occupation, survival and prognostic factors.
  
  
  METHODS
  Review of medical records of patients with MM from 1984 to 2010 from a Danish Occupational clinic. Survival was estimated using Kaplan-Meier survival analysis and prognostic factors were identified by Cox regression analysis.
  
  
  RESULTS
  110 (90.2%) patients were male, and 12 (9.8%) were female. The median (interquartile rang [IQR]) age was 65 (13) years. Pleural MM was seen in 101 (82.8%) patients, and peritoneal in 11 (9.0%); two (1.6%) had MM to tunica vaginalis testis, and eight (6.6%) to multiple serosal surfaces. We found 68 (55.7%) epithelial tumors, 26 (21.3%) biphasic, and 6 (4.9%) sarcomatoid. 12 (9.8%) patients received tri-modal therapy, 66 (54.1%) received one-/two-modality treatment, and 36 (29.5%) received palliative care. Asbestos exposure was confirmed in 107 (91.0%) patients, probable in four (3.3%), and unidentifiable in 11 (9.0%). The median (IQR) latency was 42 (12.5) years. Exposure predominantly occurred in shipyards. The median overall survival was 1.05 (95% CI: 0.96-1.39) years; 5-year survival was 5.0% (95% CI: 2.0%-13.0%). Female sex, good WHO performance status (PS), epithelial histology and tri-modal treatment were associated with a favorable prognosis.
  
  
  CONCLUSIONS
  MM continuously presents a difficult task diagnostically and therapeutically, and challenges occupational physicians with regard to identification and characterization of asbestos exposure.
authors.affiliation: Danish Ramazzini Center, Department of Occupational Medicine, Aalborg Hospital, Aarhus University Hospital, Denmark. ellenskammeritz@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Skammeritz
authors.forename: L H
authors.initials: LH
authors.lastname: Omland
authors.forename: J P
authors.initials: JP
authors.lastname: Johansen
authors.forename: O
authors.initials: O
authors.lastname: Omland
mesh_terms: D000368:Aged; D001194:Asbestos / Q000633:toxicity*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology*; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D009790:Occupations; D010997:Pleural Neoplasms / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate
chemical_list: D001194:Asbestos