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Published on: December 21, 2019
Clinical-pathological characteristics and prognostic factors for malignant peritoneal mesothelioma in the elderly
Dan Pan1, Mengyao Wang2, Wencheng Liu3
1Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, China.
Background:
Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by atypical symptoms, difficult diagnosis, variable course and poor prognosis, and it develops mainly in elderly individuals. The authors aimed to identify the clinical-pathological characteristics, prognosis, and prognostic factors in elderly MPM patients.
Methods:
From the National Cancer Institute Surveillance Epidemiology End Results (SEER) database, 1492 patients with MPM from 1975 to 2016 were selected and divided into the elderly group (≥ 65) and the adult group (< 65). We compared the clinical-pathological characteristics and treatment methods of the elderly group (N = 665) and the adult group (N = 827). At the same time, we analysed specific selected clinicopathological parameters and prognostic factors for elderly MPM patients.
Results:
Compared with the adult group, the elderly group had higher percentages of male patients (P = 0.017) and white patients (P = 0.043) and lower proportions of insured patients (P < 0.001) married patients (P < 0.001), patients with peritoneal tumours (P = 0.006) and patients who underwent surgery (P < 0.001) and chemotherapy (P < 0.001). There was a significant difference in the differentiation grade between the two groups (P = 0.003). Elderly patients had a shorter median survival time than adult patients (6 months vs. 19 months). Uninsured (hazard ratio (HR): 5.187, P = 0.005), sarcomatoid type (HR 3.913, P < 0.001), poorly differentiated (HR 3.900, P < 0.001), distant metastasis (HR 1.735, P = 0.001), no cancer-directed surgery (HR 1.733, P < 0.001), and no chemotherapy (HR 1.532, P < 0.001) were independently associated with poorer prognosis in elderly MPM patients.
Conclusion:
Compared with adult patients, elderly MPM patients had a higher male ratio, poor differentiation and relatively conservative treatment. The cancer-specific survival (CSS) rate of elderly MPM patients was significantly lower than that of adult patients. Insurance status, histology type, differentiation grade, stage, surgery status, and chemotherapy status were all independent prognostic factors for elderly MPM patients.
Insights
Elderly patients with malignant peritoneal mesothelioma (MPM) face poorer prognoses and receive more conservative treatment. Key factors impacting survival include insurance, histology, differentiation, stage, surgery, and chemotherapy.
Area of Science:
- Oncology
- Geriatric Medicine
- Cancer Epidemiology
Background:
- Malignant peritoneal mesothelioma (MPM) is a rare cancer primarily affecting elderly individuals, presenting with challenging diagnosis and poor prognosis.
- Understanding the unique clinical-pathological features and prognostic factors in elderly MPM patients is crucial for improving outcomes.
Purpose of the Study:
- To identify and analyze the clinical-pathological characteristics of elderly MPM patients.
- To determine the prognostic factors influencing survival in this specific demographic.
Main Methods:
- Utilized the National Cancer Institute Surveillance Epidemiology End Results (SEER) database, analyzing 1492 MPM cases from 1975-2016.
- Stratified patients into elderly (≥65 years) and adult (<65 years) groups for comparative analysis of characteristics and treatments.
- Performed statistical analysis to identify independent prognostic factors for elderly MPM patients.
Main Results:
- Elderly MPM patients showed higher rates of male and white patients, but lower rates of insurance and marriage compared to younger adults.
- The elderly group received less surgery and chemotherapy, and had poorer differentiation.
- Elderly patients experienced significantly shorter median survival (6 months vs. 19 months).
- Independent poor prognostic factors in the elderly included uninsured status, sarcomatoid type, poor differentiation, distant metastasis, and lack of surgery or chemotherapy.
Conclusions:
- Elderly MPM patients exhibit distinct clinical-pathological profiles, including a higher male ratio and poorer differentiation, often receiving more conservative treatment.
- Cancer-specific survival rates are significantly lower in elderly MPM patients compared to their younger counterparts.
- Insurance status, histology, differentiation grade, disease stage, and treatment (surgery, chemotherapy) are critical independent prognostic factors for elderly MPM patients.
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