Abstract: Malignant pleural mesothelioma (MPM) is a rare form of thoracic malignancy with a poor prognosis. Pleural effusion (PE) occurs in the majority of patients with MPM; however, its impact on MPM outcomes remains controversial. We searched for eligible patients from the Surveillance, Epidemiology, and End Results (SEER) database, and clinicopathological information and outcomes were collected. Cox proportional hazard regression analyses were utilized to evaluate the association of [pleural effusion (PE)] and other factors with overall survival (OS) and cancer-specific survival (CSS) in patients with MPM. A total of 4185 patients were extracted from the SEER database from 2000 to 2021. The median age of the cohort was 73 years, with a predominance of male patients and epithelioid MPM as the main histological subtype. Univariate Cox regression revealed associations between [pleural effusion (PE)], age, sex, marital status, histology, stage, and treatment with both OS and CSS. Besides, multivariate analyses indicated that PE was independently associated with poorer OS and CSS in patients with MPM, regardless of age, sex, histology, stage, and treatment. Subgroup analyses suggested that PE has a remarkable impact on patients undergoing surgery. [Pleural effusion (PE)] might serve as an independent prognostic factor in patients with MPM, especially in surgery recipients. Consequently, the development of pleural effusion in these patients should receive increased attention. Future studies are needed to validate these findings, particularly concerning the effect of [pleural effusion (PE)] in other clinical settings, such as immunotherapy.
Introduction: Malignant mesothelioma is a rare malignancy originating from mesothelial cells, with malignant pleural mesothelioma (MPM) being the main form. It is confirmed that some occupational exposures, such as asbestos and erionite, play critical roles in the development of MPM. Additionally, iatrogenic exposure to radiotherapy could also increase the risk of developing second malignancies, including malignant mesothelioma. The latest epidemiological data from World Health Organization (WHO) revealed that approximately 30,000 new cases and new deaths of mesothelioma occurred globally each year, accounting for 0.2% and 0.3% of all malignancies, respectively. Although not common in clinical settings, the disease burden of MPM should not be underestimated due to the lack of curative treatment and poor prognosis, of which the median survival is less than 2 years, with a low 5-year survival rate. MPM is mainly classified into three histological subtypes: epithelial, biphasic, and sarcomatoid. Among them, the epithelioid subtype is associated with better prognosis, whereas patients with sarcomatoid histology had the worst outcomes, with a median survival of only 4 months. Meanwhile, MPM is often accompanied by pleural effusion (PE) on initial diagnosis or during disease development, and it is proved that the presence of [pleural effusion (PE)] can lead to worse life quality10. However, limited evidence focused on the prognostic role of PE on MPM. This study aimed to explore the prognostic impact of [pleural effusion (PE)] in patients with MPM. [Footnotes omitted]
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