Predicting Survival for Malignant Mesothelioma

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Predicting Survival for Malignant Mesothelioma


Malignant mesothelioma (MM) of the pleura or peritoneum is a universally fatal disease attracting an increasing range of medical interventions and escalating health care costs. Changes in survival and the factors affecting survival of all patients ever diagnosed with MM in Western Australia over the past five decades and confirmed by the Western Australian Mesothelioma Registry to December 2005 have been examined. Sex, age, date and method of diagnosis, site of disease and histological type were recorded. Date of onset of symptoms and performance status were obtained from clinical notes for a sample of cases. Cox regression was used to examine the association of the clinical variables and the 10 year periods of disease onset with survival after diagnosis. Survival was inversely related to age, worse for males (HR 1.4 95% CI 1.2–1.6), worse for peritoneal mesothelioma (HR 1.4 95% (CI 1.1–1.7) and for those with poor performance status. Patients with sarcomatoid histology had worse prognosis than patients with epithelioid and bi-phasic histological sub-types. Survival improved after the 1970s and has made incremental improvements since then. Median (interquartile range) survival by decade, from 1960 until 2005, in days were 64 (0–198), 177 (48–350), 221 (97–504), 238 (108–502), and 301 (134–611): about 4 weeks of this apparent improvement can be attributed to earlier diagnosis. With increasing resources and treatment costs for MM over the past 40 years there have been modest improvements in survival but no complete remissions.

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