222P Women: The other face of malignant pleural mesothelioma

      Background: Malignant pleural mesothelioma (MPM) is a rare asbestos-related malignancy known to affect men in high-risk occupations. Recent publication data have suggested an increase in MPM cases among women but with a potential survival advantage of female gender. We sought to investigate gender differences in epidemiology, clinical characteristics and outcome among our MPM patients.
      Methods: We retrospectively reviewed the medical records of all MPM patients diagnosed in our center between 2000 and 2017. Data regarding demographics, asbestos exposure, symptoms, histology, tumor staging, CT findings, treatment and outcome were obtained for all patients.
      Results: We identified 29 cases of MPM, of which 38% occurred in women. The median age at diagnosis was similar for both genders (79 years in women vs 77 years in men). Domestic environment was the most important source of asbestos exposure for women (36%) whereas the vast majority of men cases (67%) were related to occupational exposure. In a significant proportion of women (54%) no source of asbestos exposure could be identified. The most common presenting symptom in the overall cohort was dyspnea, but women were more likely to present with cough and chest pain (82% vs 33% for cough; 73% vs 28% for chest pain). Pleural plaques were found in 36% of women and 72% of men. The median time to diagnosis was 2 months for both genders. Stage IV (TNM) disease was diagnosed in 64% of women and 83% of men. Women had a worse performance status at diagnosis (ECOG > 3 in 27% vs 5% in men). The main therapeutic strategies were best supportive care in women (64%) and chemotherapy in men (56%). There was a trend towards distant progression of the disease in women (54%) and local progression with invasion of lung parenchyma in men (44%). One-year survival rate was inferior in women (27% vs 39%).
      Conclusions: In our cohort, women didn't fit the traditional mesothelioma patient profile. Gender differences were found in modalities of asbestos exposure, presenting symptoms, radiological appearance, disease progression and outcome. Women demonstrated a worse 1-year survival rate, which may be attributed to the worse performance status at diagnosis, lower proportion of women treated with chemotherapy and higher rate of distant metastasis.
      Legal entity responsible for the study: Centro Hospitalar de Trás-os-Montes e Alto Douro
      Funding: Has not received any funding
      Disclosure: All authors have declared no conflicts of interest.