AbstractBackgroundMalignant pleural mesothelioma (MPM) is an aggressive cancer of the cells lining the pleural cavity with a low overall incidence. The National Cancer Database (NCDB) released in August 2022 updated data that reflect the newest trends in MPM.MethodsThe NCDB was queried for patients diagnosed with MPM between 2004 and 2020. Variables collected included demographics, tumor characteristics, and treatment. Student'st‐test and independent‐samples proportions test were used for means analysis. Survival was assessed by the Kaplan–Meier method using SPSS version 28.ResultsA total of 41,074 patients were diagnosed with mesothelioma, with a steady incidence (0.25%) between 2004 and 2017. The mean age of diagnosis was 70 (SD 13). 73.2% of the patients were males, 69% had no comorbidities, and 93.3% were white. More patients were diagnosed at Stage 1 after 2008 (p< 0.001). Since 2010, there has been a significant increase in patients offered treatment with 73.9% receiving some therapy (p< 0.01): 50.5% received chemotherapy, 27.6% surgery, 8.6% radiation, and 5.4% immunotherapy. The median overall survival was 10.3 months from diagnosis [95% CI: 10.2–10.5]. Risk factors associated with 30‐day mortality from surgical intervention included age (OR = 1.02,p< 0.001), male gender (OR = 1.3,p= 0.03), poorly differentiated grade (OR = 2.1,p< 0.001), Stage 4 (OR = 1.4,p= 0014), and epithelioid histology (OR = 0.51,p= 0.03).ConclusionThe current management of MPM is based on stage and histologic subtype. Due to the small numbers of patients at most academic centers, the NCDB provides a robust dataset to draw upon broad data points in treatment discussions with patients.