Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Meyerhoff, RR; Yang, C-FJ; Speicher, PJ; Gulack, BC; Hartwig, MG; D'Amico, TA; Harpole, DH; Berry, MF

Published Date

  • June 1, 2015

Published In

Volume / Issue

  • 196 / 1

Start / End Page

  • 23 - 32

PubMed ID

  • 25791825

Pubmed Central ID

  • PMC4430361

Electronic International Standard Serial Number (EISSN)

  • 1095-8673

Digital Object Identifier (DOI)

  • 10.1016/j.jss.2015.01.043


  • eng

Conference Location

  • United States