title: Determinants of Survival in Malignant Pleural Mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) Study of 14,228 Patients.
abstract: BACKGROUND
  Left untreated, malignant pleural mesothelioma (MPM) is associated with uniformly poor prognosis. Better survival has been reported with surgery-based multimodality therapy, but to date, no trial has demonstrated survival benefit of surgery over other therapies. We evaluated whether cancer-directed surgery influenced survival independently from other predictors in a large population-based dataset.
  
  
  METHODS
  The SEER database was explored from 1973 to 2009 to identify all cases of pathologically-proven MPM. Age, sex, race, year of diagnosis, histology stage, cancer-directed surgery, radiation, and vital status were analyzed. The association between prognostic factors and survival was estimated using Cox regression and propensity matched analysis.
  
  
  RESULTS
  There were 14,228 patients with pathologic diagnosis of MPM. On multivariable analysis, female gender, younger age, early stage, and treatment with surgery were independent predictors of longer survival. In comparison to no treatment, surgery alone was associated with significant improvement in survival [adjusted hazard ratio (adj HR) 0.64 (0.61-0.67)], but not radiation [adj HR 1.15 (1.08-1.23)]. Surgery and radiation combined had similar survival as surgery alone [adj HR 0.69 (0.64-0.76)]. Results were similar when cases diagnosed between 1973 and 1999 were compared to cases diagnosed between 2000 and 2009.
  
  
  CONCLUSIONS
  Despite developments in surgical and radiation techniques, the prognosis for MPM patients has not improved over the past 4 decades. Cancer-directed surgery is independently associated with better survival, suggesting that multimodal surgery-based therapy can benefit these patients. Further research in adjuvant treatment is necessary to improve prognosis in this challenging disease.
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.|Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, New York, 10029, United States of America.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Taioli
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Wolf
authors.affiliation: Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, 10031, United States of America.
authors.forename: Marlene
authors.initials: M
authors.lastname: Camacho-Rivera
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kaufman
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nicastri
authors.affiliation: Department of Oncology, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rosenzweig
authors.affiliation: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1023, New York, New York, 10029, United States of America.
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D012737:Sex Factors; D015996:Survival Rate; D055815:Young Adult