Introduction and objectives Since 2006 the National Lung Cancer Audit has provided increasingly comprehensive data on diagnosis, management and survival in patients with malignant mesothelioma on the UK. However, comparisons over a longer time period are hindered by a lack of comparable data. A previous population-based study of mesothelioma in Leeds, UK provided information on patients diagnosed between 2002 and 2005 (Thorax 2008;63:435). This current study describes the results of a matched analysis covering the years 2008–2013, allowing comparison with a historical cohort.
Methods 140 patients diagnosed with malignant pleural mesothelioma within the geographical boundaries of Leeds (CCG) were identified from 2008 to 2013 using Cancer Registry and National Lung Cancer Audit data. Clinical records from Leeds Teaching Hospitals (n = 136) or surrounding district hospitals (n = 4) were reviewed for information relating to disease characteristics at presentation, management and survival.
Results Clinical information for the current cohort is shown in Table 1 alongside data from the matched historical cohort from 2002–2005. The incidence per 100,000 population fell from 4.9 in 2002–2005 to 2.9 in 2008–2013. This partly reflects an increase in the population of the area covered over the time period (from 750,000 as described in the previous study to 806,683 in the current period).
Comparing earlier and later cohorts, there was a significant increase in the proportion of patients with a specific histological subtype (36% vs 86% respectively, p < 0.001) with a large rise in the proportion of epithelioid cases (32% vs 71% respectively). Similarly, comparing management of pleural effusion, the use of talc insufflation remained similar (38% vs 44% respectively) with increased use of indwelling pleural catheters (12% vs 22% respectively) and a reduction in talc slurry pleurodesis (15% vs 1% respectively). Overall treatment rates with palliative chemotherapy rose from 18% to 38% (p = 0.0002). Median survival rose from 267 days (95% CI 178–356) to 380 days (95% CI 252–397) between the two cohorts.
Conclusions The current study shows an unexpected reduction in measured incidence in Leeds, raising the possibility of incomplete case ascertainment in this study period. Specific histological subtyping, rates of palliative chemotherapy, and median survival increased between the cohorts.