Institute for Translational Epidemiology and Department of Population Health Science and Policy.
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Carcinogenesis. 2019 Jun 10;40(4):529-536. doi: 10.1093/carcin/bgz004.
Malignant pleural mesothelioma (MPM) is a rare disease with a very poor prognosis. Previous studies have indicated that women experience longer survival compared with men. We analyzed 16 267 eligible patients (21.3% females) in the National Cancer Database to evaluate which clinical factors are independently predictive of longer survival. After adjusting for all covariates, survival was significantly better in females compared with males [HRadj: 0.81, 95% confidence interval (CI): 0.77-0.85]. Other factors significantly associated with better survival were younger age at diagnosis, higher income, lower comorbidity score, epithelial histology, earlier stage and receipt of surgical or medical treatment. After propensity matching, survival was significantly better for females compared with males [hazard ratio (HR): 0.86, 95% CI: 0.80-0.94]. After propensity matching within the epithelial group, survival remained significantly better for females compared with males (HR: 0.85, 95% CI: 0.74-0.97). This study adds information to the known significant gender survival difference in MPM by disentangling the effect of gender from the effect of age and histology, two known independent factors affecting survival. Circulating estrogen, present in young but not older women, and higher expression of the estrogen receptor beta in epithelial mesothelioma have been suggested to play a role in gender survival differences. These findings may lead to exploring new therapeutic options, such as targeting estrogen receptor beta, and considering hormonal therapy including estrogens for patients with otherwise limited prognosis.
恶性胸膜间皮瘤（MPM）是一种罕见疾病，预后极差。先前的研究表明，女性的生存时间长于男性。我们分析了国家癌症数据库中 16267 名合格患者（21.3%为女性），以评估哪些临床因素可独立预测更长的生存时间。在调整了所有协变量后，女性的生存时间明显长于男性[风险比（HRadj）：0.81，95%置信区间（CI）：0.77-0.85]。其他与生存时间显著相关的因素包括诊断时年龄较小、收入较高、合并症评分较低、上皮组织学、较早的分期和接受手术或药物治疗。在倾向评分匹配后，女性的生存时间明显长于男性[风险比（HR）：0.86，95%置信区间（CI）：0.80-0.94]。在倾向评分匹配上皮组织学组内，女性的生存时间仍然明显长于男性（HR：0.85，95%置信区间（CI）：0.74-0.97）。本研究通过将性别与年龄和组织学这两个已知的独立影响生存的因素分开，为已知的 MPM 性别生存差异提供了信息。目前认为，存在于年轻女性但不存在于老年女性体内的循环雌激素，以及上皮间皮瘤中雌激素受体β的高表达，可能在性别生存差异中发挥作用。这些发现可能导致探索新的治疗选择，例如针对雌激素受体β，以及考虑对预后有限的患者进行包括雌激素在内的激素治疗。
