Carioli G, et al. - A cohort of pleural mesothelioma (PM) patients from Lombardy, the largest Italian region (about 10 million inhabitants), was examined for management, overall survival (OS), and their predictors. A wide variance was noted in the management of PM in clinical practice. Younger age and recent diagnosis were recognized as significant predictors of treatment, though a high proportion of patients were not treated. Treatment of such patients in various hospitals was documented; this points towards the importance of concentrating serious rare neoplasms in Comprehensive Cancer Centers (as recognized by the Italian Health Ministry).

• Researchers identified patients diagnosed with PM in 2006–2011 without history of cancer, via a record linkage between Lombardy health care administrative databases, and assessed their management.
• The Kaplan-Meier method was used to estimate OS from PM diagnosis.
• Using Cox regression models with time-dependent covariates when appropriate, predictors of OS and of treatment were assessed.

• Treatment for PM was received by 754 (56.9%) patients out of a total of 1,326: 205 (15.5%) underwent surgery, and 696 (52.5%) used chemotherapy.
• Data showed that surgery was spread across several hospitals.
• Surgery was performed in the same centers in most of the patients diagnosed in nonspecialized centers (70%) .
• Age at diagnosis was identified as a strong inverse determinant of surgery.
• Younger age, a more recent first diagnosis, and first diagnosis in a specialized center were documented as the determinants of receiving chemotherapy.
• Findings demonstrated that OS was 45.4% at 1 year, 24.8% at 2 years, and 9.6% at 5 years (median 11 months).
• In addition, researchers noted that OS decreased with age, and was higher for those who underwent surgery, but not for those treated with chemotherapy.