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An Investigation of Cancer-Directed Surgery for Different Histologic Subtypes of Malignant Pleural Mesothelioma. Chest Mansur, A., Potter, A., Zurovec, A. J., Nathamuni, K. V., Meyerhoff, R. R., Berry, M. F., Kang, A., Jeffrey Yang, C. 2022

Abstract

BACKGROUND: The role of cancer-directed surgery in the treatment of stage I-IIIA malignant pleural mesothelioma (MPM) by histologic subtypes remains controversial. The objective of this study was to evaluate the survival of the different histologic subtypes for stage I-IIIA MPM stratified by cancer-directed surgery and nonoperative management.RESEARCH QUESTION: How is the histologic subtype, clinical stage, and use of cancer-directed surgery with MPM associated with overall survival?STUDY DESIGN AND METHODS: Overall survival of patients with stage I-IIIA epithelioid, sarcomatoid, and biphasic MPM in the National Cancer Database from 2004-2017 who underwent cancer-directed surgery (i.e., surgery with or without chemotherapy + radiation) or chemotherapy with or without radiation ('nonoperative management') was evaluated using KaplanMeier analysis, multivariable Cox proportional hazards analysis, and propensity score-matched analysis.RESULTS: Of 2,285 patients with stage I-IIIA MPM who met inclusion criteria, histologic subtype was epithelioid in 71% of patients, sarcomatoid in 12% of patients, and biphasic in 17% of patients. Median survival was 20 months in the epithelioid group, 8 months in the sarcomatoid group, and 13 months in the biphasic group (P < 0.01). Among patients who underwent surgery, median survival was 25 months in the epithelioid group, 8 months in the sarcomatoid group, and 15 months in the biphasic group (P < 0.01). In multivariable Cox proportional hazards analyses, surgery was associated with improved survival in the epithelioid group (P < 0.01) but not in the sarcomatoid (P = 0.63) or biphasic (P = 0.21) groups. These findings were consistent in propensity score-matched analyses for each MPM histology.INTERPRETATION: In this national analysis, cancer-directed surgery was found to be associated with improved survival for stage I-IIIA epithelioid MPM but not for biphasic or sarcomatoid MPM.

View details for DOI 10.1016/j.chest.2022.12.019

View details for PubMedID 36574925