Abstract
Background
Despite accounting for a minority of malignant pleural mesothelioma (MPM) diagnoses,
females may experience differential survival relative to males. It is unclear if there
are gender-based differences in receipt of treatment or disease-related outcomes for
patients with MPM. We therefore utilized the National Cancer Database (NCDB) to assess
patterns-of-care and overall survival (OS) among patients with MPM by gender.
Materials and Methods
Patients with histologically confirmed MPM treated from 2004 to 2013 were identified
from the NCDB. The association between female gender and OS was assessed using multivariable
Cox proportional hazards models with propensity score matching. Patterns-of-care were
assessed using multivariable logistic regression. The overall treatment effect was
tested in subsets of patients by treatment strategy, histology, and clinical stage.
Results
A total of 18,799 patients were identified, of whom 14,728 (78%) were male and 4071
(22%) were female. Females were statistically more likely to present at a younger
age, with fewer comorbidities, and with epithelioid histology. Despite these favorable
prognostic features, women were less likely to receive surgery (P ≤ .001) or chemotherapy (P ≤ .001) compared with males. On multivariable analysis, female gender was associated
with improved OS (hazard ratio, 0.83; 95% confidence interval, 0.80-0.86; P ≤ .001). Gender-based survival differences were seen across all stages, but only
among patients with epithelioid (P ≤ .001) and not biphasic (P = .17) or sarcomatoid (P = 1.00) histology.
Conclusions
Surgery and chemotherapy are disproportionately underutilized in female patients with
MPM. Despite this concerning disparity, female gender is independently associated
with improved survival relative to males. Further research to understand factors that
lead to gender disparities in MPM is warranted.
Keywords
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Article info
Publication history
Published online: May 23, 2020
Accepted:
May 14,
2020
Received in revised form:
April 26,
2020
Received:
October 16,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
