Primary mesothelioma of the tunica vaginalis is a poorly understood disease.

Margin-negative resection is paramount to improve overall survival.

There is insufficient data to recommend for or against adjuvant chemoradiotherapy.

Primary mesothelioma of the tunica vaginalis (TVM) is a rare and poorly understood malignancy with insufficient population-level data to guide management decisions.

A retrospective analysis of TVM cases recorded in the National Cancer Database from 2004 to 2015 was performed. Cases were identified using International Classification of Diseases for Oncology histology codes. Associations between demographic, clinical and therapeutic factors were analyzed using Kaplan-Meier survival estimates for overall survival (OS) and Cox proportional hazard modeling. Propensity score matching for receipt of systemic chemotherapy was performed to assess the impact on OS.

One hundred fifty-one men with a median age of 65 years (interquartile range [IQR] 51–78) were included. Median OS from diagnosis was 72.5 months (IQR 20.2–Not Reached [NR]) after a median follow up of 34.9 months. Multivariate analysis demonstrated an increased risk of death for patients in the fourth quartile of age (hazard ratio [HR] 5.57, 95% confidence interval [CI] 1.70–18.17, P = 0.004), those with biphasic or fibrous histology (HR 2.59, 95% CI 1.15–6.42, P = 0.04) and positive surgical margins (HR 3.27, 95% CI 1.61–6.63, P = 0.001). There was no significant difference in OS associated with receiving chemotherapy (P = 0.5) even after propensity score matching (P = 0.07).

Margin-negative surgical resection is paramount to improving OS. There are insufficient data to recommend for or against adjuvant systemic chemotherapy or RT, although the limited available data does not suggest apparent benefit in terms of OS.

Mesothelioma

Tunica vaginalis

Orchiectomy

Survival

Chemotherapy

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