Primary Pericardial Mesothelioma: A Population-Based Propensity Score-Matched Analysis

      Primary pericardial mesothelioma is a rare malignancy of the mesothelial lining of the pericardium. This study aimed to evaluate the clinical characteristics and survival outcomes of these patients using a United States population-based cancer database. We queried the Surveillance, Epidemiology, and End Results program (1973–2015). Primary pericardial mesothelioma patients with complete follow-up data were included, and primary pleural mesothelioma patients were identified as controls. Propensity-score matching was used to balance individual characteristics. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival. Forty-one primary pericardial mesothelioma and 15,970 primary pleural mesothelioma patients were identified. Before matching, when compared to the pleural mesothelioma counterparts, primary pericardial mesothelioma patients were younger (median 57 vs 73 years, P < 0.001), more likely to be female (46.3% vs 20.2%, P < 0.001), more likely to be nonwhite (24.4% vs 8.4%, P = 0.001), and less likely to have been diagnosed in the most recent study decade (2006–2015, 34.1% vs 43.5%, P = 0.002). The overall 1- and 2-year survival rates were 22.0% and 12.2%, with a median survival of 2 months (IQR: 1-6). After 1:2 nearest neighbor propensity-score matching, 38 pericardial mesothelioma and 76 matched pleural mesothelioma cases were identified. The 2 matched groups had comparable baseline characteristics, including age, sex, race, year of diagnosis, histological type, and cancer history. Compared to their pleural mesothelioma counterparts, primary pericardial mesothelioma patients were less likely to receive chemotherapy (23.7% vs 50.0%, P = 0.01) and had worse overall survival (median survival: 2 vs 10 months, log-rank P = 0.006). Primary pericardial mesothelioma has worse survival outcomes than pleural mesothelioma, with a median survival of only 2 months. These patients should seek care from experienced multidisciplinary teams at tertiary care centers that handle high volumes of mesothelioma patients.

      Graphical Abstract



      CI (confidence interval), IQR (interquartile range), MPM (malignant pleural mesothelioma), PCM (primary pericardial mesothelioma), SEER (Surveillance, Epidemiology, and End Results)
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      Linked Article

      • Commentary: Limitations of Data for Primary Pericardial Mesothelioma
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Brydges and colleagues present a propensity-matched study of patients with primary pericardial mesothelioma (PCM) compared to patients with malignant pleural mesothelioma (MPM) based on SEER database from 1973 – 2015.1 Prior to matching, 41 patients with PCM were identified. The overall survivals (OS) were terrible with 22% and 12% surviving one and two years, respectively. With 1:2 propensity-matching, the authors found that patients with PCM were less likely to receive chemotherapy and had worse OS (2 versus 10 months).
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