The Annals of Thoracic Surgery 2018 September 29 [Link]
Kim S, Bull DA, Garland L, Khalpey Z, Stea B, Yi S, Hsu CC
Benefits of surgery for early stage non-epithelioid MPM have not been clearly elucidated. This study investigated whether cancer-directed surgery affects overall survival compared to non-surgical therapies for T1-T2N0M0 sarcomatoid or biphasic malignant pleural mesothelioma (MPM) patients.
Adult patients with clinical stage I or II MPM were identified in the National Cancer Database (NCDB) from 2004-2103. Patients who underwent cancer directed surgery were matched by propensity score with patients who had received chemotherapy/radiation therapy or no treatments. Overall survival was compared using a Cox proportional hazard regression model.
From NCDB queries, 878 patients with clinical stage I or II MPM with either sarcomatoid (524) or biphasic (354) histology were identified. Overall median survival was 5.5 months for patients with sarcomatoid mesothelioma. The cancer directed surgery improved overall survival compared to no surgery (median survival, 7.56 months vs. 4.21 months, respectively; P<0.01). In the biphasic group, median overall survival was 12.2 months. Again, the cancer directed surgery improved survival compared to no surgery (15.8 months vs. 9.3 months, P<0.01). For both histologies, the cancer directed surgery improved overall survival compared to those who underwent chemotherapy and/or radiation without surgery (P<0.05). The perioperative mortality was 6.0% at 30-days and 21.4% at 90-days. CONCLUSIONS: The cancer directed surgery is associated with improved survival in early stage MPM patients with non-epithelioid histology compared with those who did not have surgery or chose medical therapy. Given high peri-operative mortality, a careful patient selection and multi-disciplinary evaluation is recommended.