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Brock C. Christensen,^1,2 John J. Godleski,^1,3 Cora R. Roelofs,⁴ Jennifer L. Longacker,⁵ Raphael Bueno,⁶ David J. Sugarbaker,⁶ Carmen J. Marsit,² Heather H. Nelson,⁷ and Karl T. Kelsey^2,8

¹Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; ²Department of Pathology and Laboratory Medicine, Center for Environmental Health and Technology, Brown University, Providence, Rhode Island, USA; ³Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; ⁴Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA; ⁵Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA; ⁶Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; ⁷University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA; ⁸Department of Community Health, Center for Environmental Health and Technology, Brown University, Providence, Rhode Island, USA

Abstract
Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of < 1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors.

Objective: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis.

Methods: We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women's Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n =128) , and a subset of cases (n =80) with quantitative asbestos fiber burden measures.

Results: Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p <0.04) , as well as between nonepithelioid tumor histology and reduced survival (p <0.02) . Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight) ] into groups of low (0–99 asbestos bodies) , moderate (100–1,099) , and high fiber burden (> 1,099) , suggested a survival duration association among these groups (p =0.06) . After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI) , 0.95–9.5 ; p =0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5–15.0 ; p <0.01) versus those with moderate exposure.

Conclusion: Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.

Key words: asbestos, mesothelioma, survival. Environ Health Perspect 116:723–726 (2008) . doi:10.1289/ehp.11151 available via http://dx.doi.org/ [Online 12 February 2008]

Address correspondence to K.T. Kelsey, Brown University, Department of Pathology and Laboratory Medicine, 70 Ship St., 5th Floor West, Providence, RI 02903 USA. Telephone: 401-863-6420. Fax: 401-863-9008. E-mail: Karl_Kelsey@brown.edu

This study was supported by a research grant from the International Mesothelioma Program at Brigham and Women's Hospital, a grant from the Mesothelioma Applied Research Foundation, two grants from the National Institutes of Health/National Institute of Environmental Health Sciences (NIH/NIEHS ; training grant T32ES007155 and grant P42ES05947) , and grant CA126939 from the National Cancer Institute.

The authors declare they have no competing financial interests.

Received 11 December 2007 ; accepted 11 February 2008.