Faculty Collaboration Database

Current trends in the management of malignant peritoneal mesothelioma. Ann Surg Oncol 2014 Nov;21(12):3947-53

Date

05/21/2014

Pubmed ID

24841356

DOI

10.1245/s10434-014-3803-6

Scopus ID

2-s2.0-84918828747 (requires institutional sign-in at Scopus site)   39 Citations

Abstract

BACKGROUND: Historically, malignant peritoneal mesothelioma (MPM) has been considered an aggressive and lethal neoplasm. However, contemporary series have demonstrated improved outcomes following a combination of cytoreductive surgery and intraperitoneal chemotherapy. We sought to assess the trends in management and survival of patients with MPM in the United States.

METHODS: The Surveillance, Epidemiology, and End Results database was used to identify all patients diagnosed with malignant peritoneal mesothelioma from 1973 to 2010. Overall survival (OS) was studied with Kaplan-Meier curves and Cox regression analyses.

RESULTS: We identified 1,591 patients with MPM. Median age at diagnosis was 64 years (IQR 53-74 years) with the majority of patients presenting with metastatic disease (n = 962, 60.5 %). A total of 980 patients (61.6 %) did not receive surgical therapy. Receipt of radical cytoreduction for patients with metastatic MPM demonstrated a significant improvement in OS compared with patients not receiving surgery (20 vs. 4 months, p < 0.01). A temporal increase was observed in OS for patients receiving surgery (1991-1995: 15 vs. 2006-2010: 38 months, p = 0.1). In multivariate models, limited (HR 0.55; 95 % CI 0.48-0.63; p < 0.01) and radical (HR 0.66; 95 % CI 0.54-0.80; p < 0.01) surgery were independently associated with improved survival.

CONCLUSIONS: In the current era, approximately three of every five patients do not receive surgery when diagnosed with MPM, although a significant survival benefit is noted in select patients. The opportunity to improve patient survival with surgical therapy is lost in a significant number of MPM patients.

Author List

Miura JT, Johnston FM, Gamblin TC, Turaga KK

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Disease Management
Female
Follow-Up Studies
Humans
Hyperthermia, Induced
Lung Neoplasms
Lymphatic Metastasis
Male
Mesothelioma
Middle Aged
Neoplasm Staging
Peritoneal Neoplasms
Prognosis
Survival Rate
Young Adult