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.

中文翻译：

---

恶性胸膜间皮瘤接受治疗和生存的性别差异。

背景

尽管占恶性胸膜间皮瘤 (MPM) 诊断的少数，但相对于男性，女性的生存率可能存在差异。目前尚不清楚 MPM 患者在接受治疗或疾病相关结果方面是否存在基于性别的差异。因此，我们利用国家癌症数据库 (NCDB) 来评估 MPM 患者按性别划分的护理模式和总生存期 (OS)。

材料和方法

从 NCDB 中确定了 2004 年至 2013 年治疗的经组织学证实的 MPM 患者。使用倾向评分匹配的多变量 Cox 比例风险模型评估女性性别与 OS 之间的关联。使用多变量逻辑回归评估护理模式。通过治疗策略、组织学和临床分期，在亚组患者中测试了总体治疗效果。

结果

共确定了 18,799 名患者，其中 14,728 (78%) 名男性和 4071 (22%) 名女性。从统计学上讲，女性更可能在更年轻的时候就诊，合并症更少，并且具有上皮样组织学。尽管有这些有利的预后特征，但 与男性相比，女性接受手术 ( P  ≤ .001) 或化疗 ( P ≤ .001) 的可能性较小。在多变量分析中，女性与 OS 改善相关（风险比，0.83；95% 置信区间，0.80-0.86；P  ≤ .001）。所有阶段都存在基于性别的生存差异，但仅在上皮样 ( P  ≤ .001) 而非双相 ( P  = .17) 或肉瘤 ( P = 1.00) 组织学。

结论

手术和化疗在女性 MPM 患者中未得到充分利用。尽管存在这种令人担忧的差异，但与男性相比，女性与生存率的提高独立相关。需要进一步研究以了解导致 MPM 性别差异的因素。