Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-L'Alleud, Belgium.
Lung Cancer. 2021 Dec;162:185-193. doi: 10.1016/j.lungcan.2021.11.001. Epub 2021 Nov 10.
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer with a poor prognosis and limited treatment options. This study assessed the characteristics, treatment patterns, and outcomes for patients diagnosed with MPM in England.
As part of I-O Optimise, this retrospective cohort study analyzed data recorded in the Cancer Analysis System in England for all adult patients newly diagnosed with MPM between 2013 and 2017, with follow-up to March 2018 or death, whichever occurred first. Overall survival (OS) was estimated using Kaplan-Meier methods. A Cox regression model was used to describe the impact of sociodemographic and clinical characteristics at diagnosis on OS.
9458 patients diagnosed with MPM were analyzed. Median age at diagnosis was 75 years; 83.4% were male. Eastern Cooperative Oncology Group performance status (ECOG PS) was 0-1 for 44.5%; 2 for 11.5%; >2 for 9.1%; and missing for 34.9% of patients. TNM stage was missing for 60.4%. A majority of patients had epithelioid histology (36.4%) or not otherwise specified (NOS) MPM (43.3%). After diagnosis, 48.7% of all patients received best supportive care (BSC; no surgery, radiotherapy, SACT); 11.4% received palliative radiotherapy alone; 6.5% underwent surgery; 33.4% received systemic anticancer therapy (SACT) as initial treatment. Platinum plus pemetrexed was the main SACT regimen used in both first and second line. Median OS (8.3 months) varied by histopathology and ranged from 4.3 to 13.3 months for sarcomatoid and epithelioid MPM, respectively. After adjusting for age, sex, and ECOG PS, sarcomatoid, biphasic, and NOS MPM remained significantly associated with worse OS than epithelioid MPM (all p < 0.001). Median OS varied from 4.6 to 17.0 months for patients receiving BSC/palliative radiotherapy, and patients receiving surgery, respectively.
Outcomes for patients with MPM in England remain poor. Future studies will investigate the impact of newer therapies on the treatment patterns and survival of MPM patients.
恶性胸膜间皮瘤（MPM）是一种罕见且侵袭性强的癌症，预后较差，治疗选择有限。本研究评估了在英格兰诊断为 MPM 的患者的特征、治疗模式和结局。
作为 I-O Optimise 的一部分，本回顾性队列研究分析了 2013 年至 2017 年间在英格兰癌症分析系统中记录的所有新诊断为 MPM 的成年患者的数据，随访至 2018 年 3 月或死亡，以先发生者为准。使用 Kaplan-Meier 方法估计总生存期（OS）。使用 Cox 回归模型描述诊断时社会人口统计学和临床特征对 OS 的影响。
分析了 9458 例诊断为 MPM 的患者。中位诊断年龄为 75 岁；83.4%为男性。东部合作肿瘤学组体能状态（ECOG PS）为 0-1 占 44.5%；2 占 11.5%；>2 占 9.1%；34.9%的患者缺失。TNM 分期缺失占 60.4%。大多数患者具有上皮样组织学（36.4%）或未特指（NOS）MPM（43.3%）。诊断后，所有患者中有 48.7%接受最佳支持治疗（BSC；无手术、放疗、SACT）；11.4%单独接受姑息性放疗；6.5%接受手术；33.4%接受初始治疗时接受全身抗癌治疗（SACT）。铂类加培美曲塞是一线和二线治疗中主要的 SACT 方案。中位 OS（8.3 个月）根据组织病理学而有所不同，分别为肉瘤样和上皮样 MPM 的 4.3 至 13.3 个月。调整年龄、性别和 ECOG PS 后，肉瘤样、双相和 NOS MPM 的 OS 仍明显差于上皮样 MPM（均 P < 0.001）。接受 BSC/姑息性放疗和手术的患者的中位 OS 分别为 4.6 至 17.0 个月。
英格兰 MPM 患者的结局仍然较差。未来的研究将调查新型治疗方法对 MPM 患者治疗模式和生存的影响。
