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D. Lee

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    MINI 38 - Biology and Prognosis (ID 167)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 1
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      MINI38.14 - Surgery and Not Radiation Improves Survival in Malignant Pleural Mesothelioma (ID 3168)

      18:30 - 20:00  |  Author(s): D. Lee

      • Abstract
      • Presentation

      Surgery has a controversial role in the treatment of malignant pleural mesothelioma (MPM) as no trial has demonstrated independent survival benefit of surgery. Likewise, there is lack of consensus regarding the role of radiation in MPM. We evaluated whether cancer-directed surgery and/or radiation independently influenced MPM survival in a large population-based dataset.

      The Surveillance, Epidemiology, and End Results database was explored from 1973 to 2009 to identify all cases of pathologically-proven MPM. Age, sex, race, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed (chemotherapy data not available). The association between prognostic factors and survival was estimated using a Cox proportional hazards model.

      There were 14,228 patients with pathologic diagnosis of MPM. On multivariable analysis, female gender, younger age, localized stage, and cancer-directed surgery were independently associated with longer survival (Table). Survival was longer for patients who underwent surgery or surgery and radiation but not for those who underwent radiation only (Figure).

      Table. Association between Patient and Disease Characteristics and Survival
      Variable Category Adjusted HR (95% CI) *
      Sex Male 1 (Ref)
      Female 0.78 ( 0.75-0.82)
      Race White 1 (ref)
      Black 1.07 (0.98-1.16)
      Other 0.99 (0.89-1.09)
      Age (years) continuous 1.24 (1.22-1.26)
      Stage Localized 1 (ref)
      Regional 1.30 (1.21-1.40)
      Distant 1.34 (1.26-1.42)
      Diagnosis year 1973-1989 1 (ref)
      1990-1994 0.91 (0.85-0.97)
      1995-1999 0.86 (0.81-0.92)
      2000-2004 0.86 (0.81-0.91)
      2005-2009 0.80 (0.75-0.84)
      Therapy No radiation or surgery 1 (ref)
      Radiation only 1.17 (1.10-1.25)
      Surgery only 0.65 (0.62-0.68)
      Radiation and surgery 0.69 (0.63-0.75)
      Figure 1

      In this study of 14,228 patients over 36 years, cancer-directed surgery was associated with better survival in MPM, independent of other forms of therapy, including radiation. These data support the role of surgery-based therapy as the cornerstone for treatment in this challenging disease.

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