Ayrton Bangolo, Pierre Fwelo, Amer Jarri, Sai P Pulipaka, Vignesh K Nagesh, Nikita Wadhwani, Budoor Alqinai, Sidra Sohail, Geetha Keshav, Angel A Chacko, Aiswarya Menon, Luis Periel, Zuhair S Siddiqui, Bibek Pyakurel, Sandra Kunnel, Matthew Maturasingh, Gillan Quirequire, Jerusha Gudapati, Ashfi Hoque, Zubair Habib, Varun Rao, Jasmine K Grewal, Abraham Lo, Simcha Weissman
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Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors.</p><p><strong>Results: </strong>Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. Nonmalignant pleural effusion, based on histology, was associated with higher CSM (HR = 1.22, 95% CI 1.05-1.4, p < 0.05).</p><p><strong>Conclusion: </strong>Fibrous mesothelioma, older age, and distant disease were associated with increased mortality. All intervention strategies were associated with improved survival outcomes. Earlier diagnosis may improve outcomes, as available interventions are associated with lower mortality when feasible at diagnosis. The study paves the way for further prospective and retrospective studies to focus on the identification of patient subsets that may benefit from early mesothelioma screening.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"14-20"},"PeriodicalIF":0.9000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466331/pdf/","citationCount":"0","resultStr":"{\"title\":\"Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade.\",\"authors\":\"Ayrton Bangolo, Pierre Fwelo, Amer Jarri, Sai P Pulipaka, Vignesh K Nagesh, Nikita Wadhwani, Budoor Alqinai, Sidra Sohail, Geetha Keshav, Angel A Chacko, Aiswarya Menon, Luis Periel, Zuhair S Siddiqui, Bibek Pyakurel, Sandra Kunnel, Matthew Maturasingh, Gillan Quirequire, Jerusha Gudapati, Ashfi Hoque, Zubair Habib, Varun Rao, Jasmine K Grewal, Abraham Lo, Simcha Weissman\",\"doi\":\"10.55729/2000-9666.1384\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Malignant Pleural Mesothelioma (MPM) is a primary pleural tumor with scarce prognostic data estimates given its rarity. This study aims to explore the epidemiologic and survival predictors amongst patients with MPM, extending from the largest and most recent study conducted between 1973 and 2009.</p><p><strong>Methods: </strong>3384 patients diagnosed with MPM between 2010 and 2017 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors.</p><p><strong>Results: </strong>Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. 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引用次数: 0
摘要
背景：恶性胸膜间皮瘤（MPM）是一种原发性胸膜肿瘤，由于其罕见性，预后数据估计很少。本研究旨在从 1973 年至 2009 年间进行的最大规模和最新的研究中延伸，探索 MPM 患者的流行病学和生存预测因素。对人口统计学、临床特征、总死亡率（OM）和癌症特异性死亡率（CSM）估计值进行了分析。采用多变量考克斯模型确定独立的预后因素，其中危险比（HR）大于1表示不良预后因素：我们的队列显示男性居多（77.16%），超过80%的患者在59岁以后确诊，60-79岁之间达到高峰（60.17%）。上皮样间皮瘤（41.78%）、非西班牙裔白人（78.13%）和远期诊断（71.60%）是各自类别中最常见的亚组。365名患者（10.79%）在确诊时没有胸腔积液。在多变量分析中，总死亡率（OM）较高与男性（HR = 1.24，95% CI 1.14-1.37，p < 0.01）、年龄大于 80 岁（HR = 2.17，95% CI 1.41-3.35，p < 0.01）、纤维间皮瘤（HR = 2.21，95% CI 1.95-2.51，p < 0.01）和远期分期（HR = 1.55，95% CI 1.34-1.81，p < 0.01）有关。癌症特异性死亡率（CSM）较高与男性（HR = 1.25，95% CI 1.13-1.38，p < 0.01）、年龄大于 80 岁（HR = 2.02，95% CI 1.29-3.15，p < 0.01）、纤维间皮瘤（HR = 2.24，95% CI 1.97-2.55，p < 0.01）和远期分期（HR = 1.59，95% CI 1.36-1.87，p < 0.01）有关。接受任何类型治疗的患者的OM和CSM均较低。基于组织学的非恶性胸腔积液与较高的CSM相关（HR = 1.22，95% CI 1.05-1.4，p < 0.05）：结论：纤维间皮瘤、高龄和远处疾病与死亡率增加有关。所有干预策略都与生存结果的改善有关。早期诊断可能会改善预后，因为在诊断可行的情况下，可用的干预措施与较低的死亡率相关。这项研究为进一步的前瞻性和回顾性研究铺平了道路，这些研究的重点是确定可能从早期间皮瘤筛查中获益的患者亚群。
Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade.
Background: Malignant Pleural Mesothelioma (MPM) is a primary pleural tumor with scarce prognostic data estimates given its rarity. This study aims to explore the epidemiologic and survival predictors amongst patients with MPM, extending from the largest and most recent study conducted between 1973 and 2009.
Methods: 3384 patients diagnosed with MPM between 2010 and 2017 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors.
Results: Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. Nonmalignant pleural effusion, based on histology, was associated with higher CSM (HR = 1.22, 95% CI 1.05-1.4, p < 0.05).
Conclusion: Fibrous mesothelioma, older age, and distant disease were associated with increased mortality. All intervention strategies were associated with improved survival outcomes. Earlier diagnosis may improve outcomes, as available interventions are associated with lower mortality when feasible at diagnosis. The study paves the way for further prospective and retrospective studies to focus on the identification of patient subsets that may benefit from early mesothelioma screening.
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