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Current trends in the management of malignant peritoneal mesothelioma
John T Miura1, Fabian M Johnston, T Clark Gamblin
1Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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.
Insights
Malignant peritoneal mesothelioma (MPM) survival is significantly improved with cytoreductive surgery. Despite this benefit, many MPM patients do not receive surgical therapy, missing a crucial opportunity to enhance outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Epidemiology
Background:
- Malignant peritoneal mesothelioma (MPM) historically has a poor prognosis.
- Recent advancements show improved outcomes with cytoreductive surgery and chemotherapy.
Purpose of the Study:
- To assess management trends and survival outcomes for MPM patients in the United States.
- To evaluate the impact of surgical intervention on MPM patient survival.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database (1973-2010).
- Identified 1,591 MPM patients.
- Analyzed overall survival (OS) using Kaplan-Meier curves and Cox regression.
Main Results:
- 60.5% of patients presented with metastatic disease.
- 61.6% of patients did not receive surgical therapy.
- Radical cytoreduction significantly improved OS (20 vs. 4 months; p < 0.01).
- OS for surgical patients increased over time (1991-1995: 15 months vs. 2006-2010: 38 months).
- Both limited and radical surgery were independently associated with improved survival (p < 0.01).
Conclusions:
- A majority of MPM patients still do not receive surgery.
- Surgical therapy offers a significant survival benefit for select MPM patients.
- Failure to offer surgery to eligible patients represents a missed opportunity for improved outcomes.