All 123 malignant mesothelioma patients in York and North Yorkshire between 2002–2011 were analysed from Cancer Registry and Office for National Statistics data using Kaplan-Meier survival graphs, Pivot tables, multivariate analysis (Cox proportional hazard model) and log rank testing using SPSS v19 and Excel 2010.
Mesothelioma incidence, diluted by a rural hinterland, rose over 10 years from 2 to 16 per million compared with HSE data for overall UK incidence (2006–8) of 62.3 per million (male) and 11.6 per million (female). Annual mesothelioma deaths as a proportion of all deaths rose over 10 years from 0.02 to 0.17%. 87% cases were male, mean age of presentation was 72 years (range 34–95 years), and overall median and 95% Confidence Interval (CI) survival of 8 (5.8–10.2) months.
Median (CI) survival was 11 (8.6–13.4) months for patients < 75 years age, greater than for >75 years of 3 (0.7-5.3) months (p=0.005). There was a significantly greater survival of patients with performance status (PS) 0 or 1 at 11 (8.2–13.8) months compared to PS 2.3 or 4 at 2, (9–3.1; p=0.0000002) months.
Multivariate analysis, using a Cox proportional hazards regression model showed epithelioid histology subtype predicted longer survival compared to sarcomatoid (Hazard ratio 0.11 (CI 0.02–0.52; p=0.005); see Fig.1).
Survival analysis using a log rank test showed no significant difference between median (CI) survival of men 8 (6.0–10.0) months and women 5 (0–11.9; p=0.7) months. Other variables not significantly affecting survival were side of tumour (p=0.9), and diagnosing hospital (p=0.07).
Extrapleural pneumonectomy (EPP) was performed on 10 patients (5 male, PS 0–1, age 34–76 years). Survival for patients receiving EPP was 20.0 (3.3–36.7) months, significantly greater than 7.0 (4.2–9.5) months for all patients (p=0.023). No statistically significant survival benefit for EPP was seen compared with survival of 49 patients matched for age and PS (p=0.182); these findings were confirmed by multivariate analysis.
We conclude that mesothelioma represents an increasing burden and that patient factors, not treatment, govern survival.