National Cancer Data Base Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma

Journal of Thoracic Oncology 2017 August 23 [Epub ahead of print] [Link]

Verma V, Ahern CA, Berlind CG, Lindsay WD, Sharma S, Shabason J, Culligan MJ, Grover S, Friedberg JS, Simone CB

Abstract

INTRODUCTION:
Controversy exists regarding the optimal surgical technique for malignant pleural mesothelioma (MPM). We evaluated national practice patterns and outcomes of MPM treated with extrapleural pneumonectomy (EPP) versus lung-sparing extended pleurectomy/decortication (P/D).
METHODS:
The National Cancer Data Base was queried for newly-diagnosed MPM patients undergoing EPP or P/D. Multivariable logistic regression ascertained clinical factors independently associated with P/D receipt. Kaplan-Meier analysis evaluated overall survival (OS) between cohorts; multivariable Cox proportional hazards modeling evaluated factors associated with OS. Survival was then evaluated between propensity-matched populations.
RESULTS:
Overall, 1,307 patients (n=271 (21%) EPP, n=1,036 (79%) P/D) met criteria. Patients receiving P/D were older (p=0.028), whereas those undergoing EPP more likely lived in rural areas (p=0.044), farther from the treating facility (p=0.039), and treated at academic centers (p=0.050). There were no differences between cohorts in 30-day readmission or mortality (all p>0.05). Median OS in the EPP and P/D groups was 19 versus 16 months (p=0.120); no differences were observed after propensity-matching (p=0.540).
CONCLUSIONS:
In the largest such analysis to date, findings from this contemporary cohort demonstrate that P/D comprised the majority of surgical procedures for MPM. Procedure type was influenced by sociodemographic and geographical factors, without observed differences in survival or postoperative mortality/readmission rates between techniques.