European Epidemiology of Pleural Mesothelioma – Real-life data from a joint analysis of the Mesoscape database of the European Thoracic Oncology Platform and the European Society of Thoracic Surgery Mesothelioma database

Journal of Thoracic Oncology 2023 June 23 [Link]

Isabelle Opitz, Andrea Bille, Urania Dafni, Kristiaan Nackaerts, Luca Ampollini, Marc de Perrot, Luka Brcic, Ernest Nadal, Konstantinos Syrigos, Steven G Gray, Joachim Aerts, Alessandra Curioni-Fontecedro, Jan H Rüschoff, Kim Monkhorst, Birgit Weynand, Enrico Maria Silini, Fatemeh Bavaghar-Zaeimi, Marko Jakopovic, Roger Llatjos, Sotirios Tsimpouki, Stephen P Finn, Jan von der Thüsen, Nesa Marti, Georgia Dimopoulou, Roswitha Kammler, Solange Peters, Rolf A Stahel, Pierre-Emmanuel Falcoz, Alessandro Brunelli, Paul Baas


Introduction: Pleural mesothelioma (PM) is an aggressive malignancy with increasing prevalence and poor prognosis. Real-life data are a unique approach to reflect the reality of PM epidemiology, treatment, and prognosis in Europe.

Patients and methods: A joint analysis of the European Thoracic Oncology Platform (ETOP) Mesoscape and the European Society of Thoracic Surgeons (ESTS) databases was performed to better understand the characteristics and epidemiology of PM, including histology, staging, and treatment. Overall survival (OS) was assessed, adjusting for parameters of clinical interest.

Results: The analysis included 2766 patients (Mesoscape:497/10 centers / ESTS:2269/77 centers). The primary histology was epithelioid (71%), with 57% stage III-IV patients. Within Mesoscape, patients received either multimodality (59%) or palliative intention treatment (41%). The median follow-up was 47.2 months, based on 1103 patients (Mesoscape:491/ESTS:612) with 823 deaths and median OS 17.4 months. In multivariable analysis, female gender, epithelioid subtype, and lower stage were associated with longer OS, when stratifying by cohort, age, and ECOG PS. Within Mesoscape, multimodality treatment including surgery was predictive of longer OS (HR=0.56 (95%CI:0.45-0.69)), adjusting for gender, histologic subtype, and ECOG PS. Overall, surgical candidates with a macroscopic complete resection (MCR) had a significantly longer median OS compared to patients with R2 (25.2m vs 16.4m; log-rank p<0.001).

Conclusion: This combined ETOP/ESTS database analysis offers one of the largest databases with detailed clinical and pathological outcome. Our finding reflects a benefit for selected patients that undergo multimodality treatment, including MCR, and represents a valuable resource to inform the epidemiology and treatment options for individual patients.