Surgery improves OS in malignant pleural mesothelioma

Surgical treatment improved outcomes of patients with malignant pleural mesothelioma, according to a SEER database analysis.

Researchers even observed the benefit among elderly individuals.

More than half of patients diagnosed with malignant pleural mesothelioma (MPM) are elderly, and increasing age is associated with shorter survival. However, the effect of surgery on survival in this population had not been established.

“Quantitative data to support difficult treatment decisions about when to offer surgery for elderly MPM patients are needed, as a subset of these patients with favorable prognostic factors may experience extended survival by undergoing cancer-directed surgery,” Chi-Fu Jeffrey Yang, MD, of the department of surgery in the division of thoracic surgery at Duke University Medical Center, and colleagues wrote.

Yang and colleagues evaluated SEER data to determine whether age influenced OS among patients with stage I to III MPM who underwent cancer-directed surgery or nonoperative management.

The analysis included 879 patients, 282 (32%) of whom underwent cancer-directed surgery.

Patients who underwent surgery were younger than those who received nonoperative management (median age, 67 years vs. 74 years). Those who underwent surgery also had higher clinical stage disease and slightly higher frequency of biphasic disease, and they were more likely to be married.

Results showed a higher 30-day mortality in the nonoperative management group than the surgery group (11.7% vs. 4.3%; P = .001).

Researchers reported higher rates of OS in the surgery group at 1 year (63% vs. 44%) and 3 years (21% vs. 11%). However, long-term survival was poor in both groups, Yang and colleagues wrote.

Use of cancer-directed surgery was the strongest predictor of longer survival (HR = 0.71; 95% CI, 0.58-0.86, whereas age (HR = 1.03; 95%CI, 1.02-1.03) and biphasic histology (HR = 1.51; 95% CI, 1.22-1.86) were associated with shorter survival.

Patients aged 70 years or older were less likely than those aged younger than 70 years to undergo cancer-directed surgery (22% vs. 46%; P < .001).

However, among patients aged 70 and older, results showed a higher percentage of those who underwent surgery survived 1 year (59.4% vs. 37.9%) and 3 years (15.4% vs. 8%).

Multivariable analysis showed surgery did not confer a survival benefit among patients aged older than 80 years (HR = 0.96; 95% CI, 0.57-1.61).

“Future research should focus on evaluating the comorbidities and characteristics that are most important in the elderly population to optimize both perioperative outcomes and long-term survival,” Yang and colleagues wrote.

The researchers acknowledged the study was limited by the lack of information about comorbidities, socioeconomic status and chemotherapy regimens, as well as lack of details about clinical and pathologic staging.

“While these results cannot be used to show definitive benefit to surgery in all elderly patients, the analysis does suggest that advanced age alone should not be used as an absolute contraindication to surgery,” Yang and colleagues wrote. “Even elderly patients should go through a multidisciplinary evaluation to decide if surgery should be part of their treatment regimen.” – by Kristie L. Kahl

Disclosure: The researchers report no relevant financial disclosures.