(P102) Surgery Improves Survival in 14,228 Patients With Malignant Pleural Mesothelioma

Publication
Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

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.

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

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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