Author of

• 31105

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  P2.06 - Mesothelioma (ID 170)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Mesothelioma
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31114

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    P2.06-09 - Drop the Scalpel: Long-Term Survival in Mesothelioma Without Extrapleural Pneumonectomy or Pleurectomy Decortication (ID 2610)

    10:15 - 18:15  |  Author(s): Ananya Anand
    • Abstract

    Background
    

    Survival times following multimodality treatment with extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) for malignant pleural mesothelioma (MPM) are poor with a need to identify factors that predict long-term survival.

    Method
    

    A retrospective single-institution review was performed on all patients who underwent EEP or P/D for histologically confirmed MPM between 1996 and 2015. Patients who underwent a diagnostic biopsy or limited tumor excision were included for survival comparison in a non-operative group (NO). Clinical characteristics, perioperative outcomes, stage, nodal disease, R1 versus R2 resection, treatment modalities, and survival data were collected. The top decile of patients with longest overall survival were studied in subgroup analysis as “long-term survivors.”

    Result
    

    A total of 206 patients with MPM underwent any type of operations with a median survival time of 13 months (range, 0-134 months) and a 3-year and 5-year survival rates of 15.9% and 8.1% respectively among all patients. Median survival times following EPP (n=28), P/D (n=102) and NO (n=76) were 14 months, 13 months, and 11 months respectively. Better survival was observed in patients with epithelial histology (16 months, n=146) than biphasic histology (7 months, n=28) or sarcomatoid histology (5 months, n=27) (logrank p<.001). Patients with epithelial histology had the greatest median survival times, EPP (29 months, n=23), P/D (16 months, n=77) and NO (16 months, n=46). Three-year and 5-year overall survival rates among patients with epithelial histology were 34.7%, 14.9% after EPP, 16.7, 10.4% after PD and 25.9%, 8.1% after NO, with the patients in the NO group presenting with the most advanced disease. The top decile of long-term survivors all had epitheliod histology and were treated with a variety of chemotherapy regimens leading to a median survival of 64 months with a mean of 71 months. Patients with disease too advanced for surgical resection in the NO group were equally likely to become long-term survivors (9.2%, median survival 57 months) compared with patients who underwent major surgical resection like EPP or P/D (10.0%, median survival 72 months).

    Conclusion
    

    In this non-randomized retrospective review, patients with MPM too advanced for EPP or PD, who instead underwent palliative limited operations as part of a multimodality treatment regimen had long-term survival rates of approximately 10% that were equivalent to rates of long-term survival following major resections like EPP or P/D. Long-term survival is mesothelioma is therefore more likely determined by outside factors such as disease biology and pace of tumor growth than it is major surgical resection.