Pleural Mesothelioma and Gender Relation
There were about 13 patients missing Pleural Mesothelioma data and they were not included in the analysis as I had mentioned earlier given the difference in tumor biology for the epithelial and non-epithelial disease. I chose to stratify the analysis accordingly and these are the 450 patients with the epithelial disease.
We can see Pleural Mesothelioma affected women were younger less likely to be anemic and interestingly more likely to have thrombocytosis which is actually a negative prognosticator for the non-epithelial disease. Patients had fewer differences in fact only the hematocrit was different between the genders the stages were similar.
it’s not that women are presenting at a younger stage I mean at an earlier stage. This is the overall survival for patients with epithelial disease and as you can see here the survival for women is better when stratified by stage.
These green and purple curves represent the women the blue and red represent the men they simply do better now for patients with the non-epithelial disease there’s no difference and similarly when we stratify by stage it’s still no difference. The thought being that non-epithelial disease is such a negative prognosticator for long-term survival even the effect of gender is not seen in those patients.
The univariate analysis all predictors except for side were predictive of survival and female gender age and normal labs and stage were still significantly predictive of long-term survival and on Cox proportional hazard adjusted analysis. The hazard ratio for long-term mortality for women was 0.75.
Well, just keep that number in mind for a minute I’ll bring it to bring us back to it for patients with non-epithelial disease female gender fell out of significance and a multivariable analysis only stage normal white count and normal platelet count were predictive of long-term survival of Pleural Mesothelioma.
The conclusions from that study were that female gender conferred a 25% survival advantage in epithelial malignant pleural mesothelioma that the independent predictors for survival in epithelial disease were female gender, young age, early stage, and normal labs whereas for non epithelial disease only stage white blood cell count and platelet count being normal or predictive of long term survival of Pleural Mesothelioma.
Pleural Mesothelioma Patients Tested:
This is hot off the presses we’re presenting this at the Society of thoracic surgeons in June in January this is looking at 14,000 seer patients and you can see here these are about 3,200 women and these are 11,000 men but there’s a difference in survival interestingly on multivariable analysis the hazard ratio for female gender for all comers we don’t know the cell type of these patients.
I can tell you that epithelial disease is more common but we don’t have a reported histology in the seer database but that hazard ratio is very similar to what we found in the Brigham data so what are the implications if women are only 20% of patients with me so who cares well that’s going to change. Julianne Peto gave me this slide of Pleural Mesothelioma.
He’s an epidemiologist at the London School of Hygiene, who studies asbestos-related diseases and he is best known for his decades of modeling patterns of asbestos-related disease and particularly mesothelioma and accurately predicted predicting the numbers of patients were gonna see what this disease.
long-term survivors of Pleural Mesothelioma Patients:
Mesothelioma has about a 40- year latency period so even though asbestos has been banned for years
A: we’re still seeing patients who were exposed to it 40 years ago and
B: as dr. Flores has presented in some of his talks the asbestos is still out there.
Canada has been continuing to export it there are third world countries that continue to use it.
The point is these are the number of women expected to die from malignant pleural mesothelioma. In terms of other thoracic malignancies, there seems to be a role of gender as well and this is a whole can of worms that I’m not going to have time to go into and I myself I’m just beginning to explore.
This is one with Nova skew study in the Journal of Clinical Oncology and this is for non- small-cell lung cancer women have better survival than men given every form of treatment surgery radiation chemotherapy and even no treatment at all to Pleural Mesothelioma.
So, there’s something to this there may be differences in the types of exposure or the response to exposure. The tumor biology itself and the response to treatment both in mesothelioma and perhaps other thoracic malignancies. As I’ve shown there can we exploit these differences and help both women and men affected by Pleural Mesothelioma.
I will admit in the later years of my time in Boston we were prescribing Premarin to men with mesothelioma in advanced disease not scientific, but we thought there was something to circulating estrogen having a role in that difference in young women and the disproportionate number of young women we were seeing among long-term survivors.
In summary, Pleural Mesothelioma has come a long way from no long-term survivors to 15%. Approximately 15% five-year survival with surgery-based therapy surgical macroscopic resection can be accomplished with less morbid surgery with cleric time decortication and many of us have turned toward doing this operation preferentially when feasible.
Pleura ectomy decortication even in bulky disease further impact on improving survival in this disease. it is going to depend on advances in individualizing therapy and individualizing treatment of Pleural Mesothelioma.