Frequency of surgery in black patients with malignant pleural mesothelioma

Introduction: Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival. Methods: All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database.Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital statuswere analyzed according to self-reported race (black orwhite). Results: There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted, P = 0.01). Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancerdirected surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77.0.88)) and early stage at diagnosis (HR 0.83 (0.76.0.90)) were predictive of longer survival in white, but not in black, patients. Conclusions: Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.