Abstract
Introduction
For the 3 histologic subtypes of malignant pleural mesothelioma (MPM)—epithelioid,
sarcomatoid, and biphasic—the magnitude of benefit with surgical management remains
underdefined.
Materials and Methods
The National Cancer Data Base was queried for newly diagnosed nonmetastatic MPM with
known histology. Patients in each histologic group were dichotomized into those receiving
gross macroscopic resection versus lack thereof/no surgery. Kaplan-Meier analysis
evaluated overall survival (OS) between cohorts; multivariable Cox proportional hazards
modeling assessed factors associated with OS. After propensity matching, survival
was evaluated for each histologic subtype with and without surgery.
Results
Overall, 4207 patients (68% epithelioid, 18% sarcomatoid, 13% biphasic) met the study
criteria. Before propensity matching, patients with epithelioid disease experienced
the highest median OS (14.4 months), followed by biphasic (9.5 months) and sarcomatoid
(5.3 months) disease; this also persisted after propensity matching (P < .001). After propensity matching, surgery was associated with significantly improved
OS for epithelioid (20.9 vs. 14.7 months, P < .001) and biphasic (14.5 vs. 8.8 months, P = .013) but not sarcomatoid (11.2 vs. 6.5 months, P = .140) disease. On multivariable analysis, factors predictive of poorer OS included
advanced age, male gender, uninsured status, urban residence, treatment at community
centers, and T4/N2 disease (all P < .05). Chemotherapy and surgery were independently associated with improved OS,
as was histology (all P < .001).
Conclusion
This large investigation evaluated surgical practice patterns and survival by histology
for MPM and found that histology independently affects survival. Gross macroscopic
resection is associated with significantly increased survival in epithelioid and biphasic,
but not sarcomatoid, disease. However, the decision to perform surgery should continue
to be individualized in light of available randomized data.
Keywords
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Article info
Publication history
Published online: August 28, 2018
Accepted:
August 11,
2018
Received in revised form:
July 23,
2018
Received:
March 2,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
