Changing pattern in malignant mesothelioma survival.
Survival for mesothelioma has been shown to be poor, with marginal improvement over time. Recent advances in the understanding of pathophysiology and treatment of mesothelioma may impact therapy to improve survival that may not be evident from available clinical trials that are often small and not randomized. Therapies may affect survival differently based on mesothelioma location (pleural vs peritoneal). Data are conflicting regarding the effect of asbestos exposure on mesothelioma location.


OBJECTIVE
We examined survival in a large cohort of mesothelioma subjects analyzed by tumor location and presence and mode of asbestos exposure.


METHODS
Data were analyzed from cases (n = 380) diagnosed with mesothelioma from 1992 to 2012. Cases were either drawn from treatment referrals, independent medical evaluation for medical legal purposes, or volunteers who were diagnosed with mesothelioma. Subjects completed an occupational medical questionnaire, personal interview with the examining physician, and physician review of the medical record.


RESULTS
This study reports better survival for mesothelioma than historical reports. Survival for peritoneal mesothelioma was longer than that for pleural mesothelioma (hazard ratio = 0.36, 95% confidence interval = 0.24-0.54, P < .001) after adjusting for gender and age at diagnosis. Non-occupational cases were more likely to be 1) diagnosed with peritoneal mesothelioma, 2) female, 3) exposed, and 4) diagnosed at a younger age and to have a 5) shorter latency compared to occupational cases (P < .001).


CONCLUSIONS
Peritoneal mesothelioma was more likely associated with non-occupational exposure, thus emphasizing the importance of exposure history in enhancing early diagnosis and treatment impact.
Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. Electronic address: johar@wakehealth.edu.
Jennifer
J
Faig
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: showard@wakehealth.edu.
Suzanne
S
Howard
Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: elevine@wakehealth.edu.
Edward A
EA
Levine
CCG, Inc, Clemmons, NC, USA. Electronic address: gcasselman@ccgteam.com.
Gary
G
Casselman
Mesothelioma Applied Research Foundation (MARF), Alexandria, VA, USA. Electronic address: info@curemeso.org.
Mary
M
Hesdorffer
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: johar@wakehealth.edu.
Jill A
JA
Ohar