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


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).
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.
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).
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.