Prognostic factors and clinical outcomes of malignant pleural mesothelioma in a real world-setting: An Asian cohort

[[abstract]]Background: There are scarce reports on the treatment and outcome of patients with malignant pleural mesothelioma (MPM) in Asia. This study aimed to assess the treatment pattern and identify significant prognostic factors in MPM patients in a real-world setting. Methods: Medical records of patients with histologically proven MPM diagnosed between 1977 and 2015 at the National Taiwan University Hospital were reviewed. Variables including age, gender, asbestos exposure, smoking history, histology subtype, staging (AJCC 7th), and treatment received were recorded. All patients were followed until death or October 31st, 2015, whichever occurred earlier. Survival and prognostic factors were analyzed by Kaplan-Meir method and Cox proportional hazard model. Results: A total of 82 patients were identified, including 59 men and 23 women. A trend of increasing newly diagnosed MPM cases was observed over the 38-year span. The median overall survival for stage I/II and stage III/IV patients was 33.4 and 7.3 months, respectively. Significant predictors for better survival included stage I/II (hazard ratio [HR] 0.29, 95% CI 0.14-0.59, p < 0.001), epithelioid histology (HR 0.50, 0.26-0.98, p = 0.043) and age below 65 (HR 0.51, 0.26-0.97, p = 0.040), whereas cigarette smoking and asbestos exposure had no significant influence. Among the 51 patients with stage III/IV disease, 20 (39.2%) underwent palliative surgery and 5 (9.8%) received palliative radiation therapy; 33 patients (64.7%) received systemic therapy, 29 (56.9%) received pemetrexed-containing regimens and 14 (27.5%) received two or more lines of treatment. The median progression-free survivals for first and second line therapies were 4.5 and 2.5 months, respectively. After adjusted by age and histology type, stage III/IV patients who received systemic therapy had a significantly better survival (HR 0.31, 0.15-0.66, p = 0.002). Conclusions: This is one of the largest case series of MPM with detailed patient data reported in Asia outside of Japan. Significant prognostic factors for MPM included stage, age, and histology subtype. In patients with advanced disease, systemic treatment may confer a better outcome