Survival after conservative (palliative) management of pleural malignant mesothelioma

Background and Objectives: Malignant mesothelioma is a lethal disease. Aggr essive multimodality treatment protocols are reportedly associated with imp roved survival, but the apparent survival benefits may simply reflect patie nt selection and the variable natural history of this malignancy. Before em barking on our own protocol of experimental treatment for mesothelioma, we sought to identify important prognostic factors and document the survival o f patients treated conservatively (with palliative intent only) in our regi on. Methods: We performed a retrospective review of all patients with a diagnos is of malignant mesothelioma seen at our center between 1987 and 1999. Sinc e curative intent treatment had not been given, we assumed that measured su rvival would largely reflect the natural history of the malignancy. Results: There were 101 patients (80 males and 21 females). Mean age was 65 +/- 9.2 years. Symptoms of disease were present for a median time of 5 mon ths before the diagnosis was established. The most common presenting sympto ms were dyspnea (46 patients), chest pain (30 patients), and weight loss (2 2 patients). Sixty-eight patients (68%) had a history of asbestos exposure. Mesothelioma subtypes included epithelial (43 patients), sarcomatous (26 p atients), mixed (19 patients), desmoplastic (4 patients), and unspecified ( 9 patients). All 101 patients were treated with palliative intent. Tale ple urodesis was performed in 70 patients. At the time of analysis, 90 patients had died and 11 remained alive. Median survival was 213 (95% CI 137-289) d ays. Survival for the three major histological subtypes was significantly d ifferent (log rank, P = 0.0016). Histological subtype (epithelial favorable ) was the only significant independent prognostic factor (Cox proportional hazard regression, P = 0.0009). Conclusions: Patients with epithelial mesothelioma survive longer than thos e with other histological subtypes. Conservatively managed patients with pl eural malignant mesothelioma have a median survival of approximately 7 mont hs. These data from conservatively treated patients can serve as baseline i nformation for future studies of experimental treatments. (C) 2001 Wiley-Li ss, Inc.