Improving outcomes in malignant pleural mesothelioma in an integrated health care system

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor that should be managed by an experienced surgical and multidisciplinary group. Our objective was to determine the impact of proficient surgeons and MPM bi-disciplinary review on outcomes of patients with MPM.

Methods: Through this cohort study, electronic medical records of 368 adult patients with MPM from 1/1/2009 to 12/31/2020 were reviewed and compared before and after MPM surgeries were regionalized to specialized surgeons and bi-disciplinary review of MPM patient treatment options. We used the Kaplan-Meier method and log-rank tests to compare survival rates by period, by treatment type, and by stage. Patients were followed from cancer diagnosis date until they died or end of study follow-up, whichever occurred first. We also conducted Cox proportional hazards regression model to examine the overall survival (OS) with adjustments for age, histology, stage, and Charlson comorbidity index (CCI).

Results: Despite similar staging, more patients received any MPM directed treatment from 2015-2020 compared with those patients from 2009-2014. Specifically, there was an increase in patients who received pleurectomy/decortication (PD) from 2015-2020 compared to those who received PD in 2009-2014. Patients with similar age, CCI, stage, and histology had an increase in OS of 12 months with multimodality therapy (surgery, systemic therapy, +/- radiation) compared to those patients who received no treatment.

Conclusions: Consolidating mesothelioma surgery to a specialized surgical team and regular bi-disciplinary review of MPM cases to determine appropriate multimodality therapy, increases the incorporation of surgical treatments in the management of patients with MPM.

Keywords: Malignant pleural mesothelioma (MPM); multimodality therapy; overall survival (OS); pleurectomy/decortication (PD); regionalization.

Figure 1

Changes in treatment from early period [2009–2014] to later period [2015–2020]. *, multimodality treatment includes surgery and systemic therapy with or without radiation. Systemic only includes systemic treatment with or without radiation. Surgery only includes surgery with or without radiation. ^‡, Chi-square test.

Figure 2

Survival of all patients by treatment type in early period [2009–2014] (A) and later period [2015–2020] (B). Multimodality treatment: surgery and systemic therapy with or without radiation. Systemic only: systemic treatment with or without radiation. Surgery only: surgery with or without radiation. None: no treatments administered.