TY - JOUR
T1 - Long-term survival outcomes of cancer-directed surgery for malignant pleural mesothelioma
T2 - Propensity score matching analysis
AU - Nelson, David B.
AU - Rice, David C.
AU - Niu, Jiangong
AU - Atay, Scott
AU - Vaporciyan, Ara A.
AU - Antonoff, Mara
AU - Hofstetter, Wayne L.
AU - Walsh, Garrett L.
AU - Swisher, Stephen G.
AU - Roth, Jack A.
AU - Tsao, Anne
AU - Gomez, Daniel
AU - Giordano, Sharon H.
AU - Mehran, Reza
AU - Sepesi, Boris
N1 - Funding Information:
Data for this study were identified by using participant user files from the NCDB, which is jointly sponsored by the American College of Surgeons Commission on Cancer and the American Cancer Society. The NCDB is a hospital-based nationwide registry that collects data from more than 1,500 Commission on Cancer–accredited facilities, which represents more than 70% of newly diagnosed cancer cases nationwide.7 The American College of Surgeons has executed a business associate agreement that includes a data use agreement with each of its Commission on Cancer– accredited hospitals. This NCDB analysis was approved by the MD Anderson Cancer Center Institutional Review Board with a waiver of individual informed consent.
PY - 2017/10/10
Y1 - 2017/10/10
N2 - Purpose Small observational studies have shown a survival advantage to undergoing cancer-directed surgery for malignant pleural mesothelioma (MPM); however, it is unclear if these results are generalizable. Our purpose was to evaluate survival after treatment of MPM with cancer-directed surgery and to explore the effect surgery interaction with chemotherapy or radiation therapy on survival by using the National Cancer Database. Patients and Methods Patients with microscopically proven MPM were identified within the National Cancer Database (2004 to 2014). Propensity score matching was performed 1:2 and among this cohort, a Cox proportional hazards regression model was used to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method. Results Of 20,561 patients with MPM, 6,645 were identified in the matched cohort, among whom 2,166 underwent no therapy, 2,015 underwent chemotherapy alone, 850 underwent cancer-directed surgery alone, 988 underwent surgery with chemotherapy, and 274 underwent trimodality therapy. The remaining 352 patients underwent another combination of surgery, radiation, or chemotherapy. Thirty-day and 90-day mortality rates were 6.3% and 15.5%. Cancer-directed surgery, chemotherapy, and radiation therapy were independently associated with improved survival (hazard ratio, 0.77, 0.74, and 0.88, respectively). Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based multimodality therapies; however, the largest estimated effect was when cancer-directed surgery, chemotherapy, and radiation therapy were combined (hazard ratio, 0.52). For patients with the epithelial subtype who underwent trimodality therapy, median survival was extended from 14.5 months to 23.4 months. Conclusion MPM is an aggressive and rapidly fatal disease. Surgery-based multimodality therapy was associated with improved survival and may offer therapeutic benefit among carefully selected patients.
AB - Purpose Small observational studies have shown a survival advantage to undergoing cancer-directed surgery for malignant pleural mesothelioma (MPM); however, it is unclear if these results are generalizable. Our purpose was to evaluate survival after treatment of MPM with cancer-directed surgery and to explore the effect surgery interaction with chemotherapy or radiation therapy on survival by using the National Cancer Database. Patients and Methods Patients with microscopically proven MPM were identified within the National Cancer Database (2004 to 2014). Propensity score matching was performed 1:2 and among this cohort, a Cox proportional hazards regression model was used to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method. Results Of 20,561 patients with MPM, 6,645 were identified in the matched cohort, among whom 2,166 underwent no therapy, 2,015 underwent chemotherapy alone, 850 underwent cancer-directed surgery alone, 988 underwent surgery with chemotherapy, and 274 underwent trimodality therapy. The remaining 352 patients underwent another combination of surgery, radiation, or chemotherapy. Thirty-day and 90-day mortality rates were 6.3% and 15.5%. Cancer-directed surgery, chemotherapy, and radiation therapy were independently associated with improved survival (hazard ratio, 0.77, 0.74, and 0.88, respectively). Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based multimodality therapies; however, the largest estimated effect was when cancer-directed surgery, chemotherapy, and radiation therapy were combined (hazard ratio, 0.52). For patients with the epithelial subtype who underwent trimodality therapy, median survival was extended from 14.5 months to 23.4 months. Conclusion MPM is an aggressive and rapidly fatal disease. Surgery-based multimodality therapy was associated with improved survival and may offer therapeutic benefit among carefully selected patients.
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U2 - 10.1200/JCO.2017.73.8401
DO - 10.1200/JCO.2017.73.8401
M3 - Article
C2 - 28817374
AN - SCOPUS:85031912587
SN - 0732-183X
VL - 35
SP - 3354
EP - 3362
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 29
ER -