Andrea S. Wolf, MD, MPH, Emanuela Taioli, MD, Marlene Camacho-Rivera, ScD, MPH, Kenneth E. Rosenzweig, MD, Raja M. Flores, MD; Mount Sinai Medical Center; North Shore/Long Island Jewish Health System, Hofstra School of Medicine
OBJECTIVES: Left untreated, malignant pleural mesothelioma (MPM) has uniformly poor prognosis. Prolonged survival has been reported with surgery-based multimodality therapy, but to date, no trial has demonstrated independent survival benefit of surgery over other therapies for MPM. We evaluated whether cancer-directed surgery independently influenced survival in a large population-based dataset.
METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was explored from 1973 to 2009 to identify all cases of pathologically proven MPM. Age, sex, race, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed (chemotherapy data not available). The association between prognostic factors and survival was estimated using a Cox proportional hazards model.
RESULTS: There were 14,228 patients with pathologically proven MPM. On multivariable analysis, female gender, younger age, early stage, and cancer-directed surgery were independent predictors of longer survival. In comparison with no treatment, surgery alone was independently associated with significantly longer survival, with an adjusted hazard ratio (aHR) for mortality of 0.65 (0.62–0.68), while radiation alone was not (aHR = 1.17 [1.10–1.25]). The combination of surgery and radiation was associated with a survival outcome similar that with to surgery alone (aHR = 0.69 [0.63–0.75]). In patients diagnosed from 2000–2009, the aHR for mortality with radiation was 1.26, 0.68 for surgery, and 0.63 for surgery plus radiation, with similar results obtained in patients diagnosed from 1973–1999. This suggests that improvements in technique over time have not altered the impact of therapy on patients with MPM.
CONCLUSIONS: Despite developments in surgery, perioperative management, and radiotherapy, the prognosis for MPM patients has not improved over the past four decades. In this SEER study of 14,228 patients over 36 years, cancer-directed surgery was associated with better survival in MPM, independent of other prognostic factors. These data support the role of surgery-based therapy as the cornerstone of treatment for this challenging disease.
Proceedings of the 97th Annual Meeting of the American Radium Society — americanradiumsociety.org