title: Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database.
abstract: BACKGROUND
  This study was conducted to determine how malignant pleural mesothelioma (MPM) histology was associated with the use of surgery and survival.
  
  
  METHODS
  Overall survival of patients with stage I-III epithelioid, sarcomatoid, and biphasic MPM in the Surveillance, Epidemiology, and End Results database from 2004-2010 was evaluated using multivariate Cox proportional hazards models.
  
  
  RESULTS
  Of 1183 patients who met inclusion criteria, histologic subtype was epithelioid in 811 patients (69%), biphasic in 148 patients (12%), and sarcomatoid in 224 patients (19%). Median survival was 14 mo in the epithelioid group, 10 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). Cancer-directed surgery was used more often in patients with epithelioid (37%, 299/811) and biphasic (44%, 65/148) histologies as compared with patients with sarcomatoid histology (26%, 58/224; P < 0.01). Among patients who underwent surgery, median survival was 19 mo in the epithelioid group, 12 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). In multivariate analysis, surgery was associated with improved survival in the epithelioid group (hazard ratio [HR] 0.72; P < 0.01) but not in biphasic (HR 0.73; P = 0.19) or sarcomatoid (HR 0.79; P = 0.18) groups.
  
  
  CONCLUSIONS
  Cancer-directed surgery is associated with significantly improved survival for MPM patients with epithelioid histology, but patients with sarcomatoid and biphasic histologies have poor prognoses that may not be favored by operative treatment. The specific histology should be identified before treatment, so that surgery can be offered to patients with epithelioid histology, as these patients are most likely to benefit.
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Immunology, Duke University, Durham, North Carolina.
authors: Robert Ryan
authors: RR
authors: Meyerhoff
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Chi-Fu Jeffrey
authors: CF
authors: Yang
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Paul J
authors: PJ
authors: Speicher
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Brian C
authors: BC
authors: Gulack
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Matthew G
authors: MG
authors: Hartwig
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Thomas A
authors: TA
authors: D'Amico
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: David H
authors: DH
authors: Harpole
authors: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California. Electronic address: berry037@stanford.edu.
authors: Mark F
authors: MF
authors: Berry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018426:SEER Program
keywords: Biphasic; Epithelioid; Fibrous; Mesothelioma; SEER; Sarcomatoid; Surgery