Browse/search for people

Publication - Dr David Carslake

    Is pleural infection associated with longer survival in mesothelioma? A population-based cohort study using data from Hospital Episode Statistics

    Citation

    Bibby, AC, Fonseka, Dd, Carslake, DJ & Maskell, NA, 2019, ‘Is pleural infection associated with longer survival in mesothelioma? A population-based cohort study using data from Hospital Episode Statistics’. Cancer Epidemiology, vol 59., pp. 75-82

    Abstract

    Background

    Historically
    pleural infection was thought to be associated with longer survival in
    thoracic malignancies. The aim of this population-based cohort study was
    to investigate this hypothesis in mesothelioma, using national data
    from a high incidence country.

    Methods

    Case
    records for all patients with mesothelioma seen in English hospitals
    between 01/01/2005 and 31/12/2014 were extracted from Hospital Episode
    Statistics using International Classification of Diseases Tenth Edition
    (ICD-10) codes. Episodes of pleural infection were identified. Linked
    mortality data was obtained from the Office of National Statistics.

    The
    primary outcome was all-cause mortality. The explanatory variable was
    pleural infection. Cox proportional hazards model was used to analyse
    survival, with pleural infection, chemotherapy and thoracic surgery
    handled as time-variable co-factors.

    Results

    Of
    22,215 patients with mesothelioma, 512 (2.3%) developed pleural
    infection at some point in their illness. Overall median survival was
    7.0 months (IQR 2.3–16.4). Pleural infection was associated with shorter
    survival in the immediate post-infection period (up to 30 days – HR
    1.81, 95% CI 1.45–2.22) and longer term (>30 days – HR 1.81, 95% CI
    1.63–1.99). Other factors associated with increased mortality were age,
    male gender and being diagnosed as an inpatient. Receiving chemotherapy
    and being less economically deprived were associated with longer
    survival.

    Conclusion

    Pleural
    infection occurred in 2.3% of people with mesothelioma and was
    associated with shorter survival. This refutes previous reports
    suggesting pleural infection may be associated with better outcomes in
    thoracic malignancy.

    Full details in the University publications repository