Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival

• Published in: Annals of surgical oncology Vol. 25; no. 7; pp. 2018 - 2026
• Main Authors: Verma, Vivek, Sleightholm, Richard L., Rusthoven, Chad G., Koshy, Matthew, Sher, David J., Grover, Surbhi, Simone, Charles B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2018; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion - mortality; Combined Modality Therapy; Cytoreduction Surgical Procedures - mortality; Disease management; Female; Follow-Up Studies; Gastric cancer; Gastrointestinal Oncology; Geography; Histology; Humans; Hyperthermia, Induced - mortality; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Medical prognosis; Medicine; Medicine & Public Health; Mesothelioma; Mesothelioma - mortality; Mesothelioma - pathology; Mesothelioma - therapy; Mesothelioma, Malignant; Middle Aged; Oncology; Outcome Assessment, Health Care; Patients; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Peritoneum; Prognosis; Retrospective Studies; Statistical analysis; Surgery; Surgical Oncology; Survival Rate; Young Adult; United States > US; National Practice Patterns; Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Malignant Peritoneal Mesothelioma (MPM); National Cancer Data Base (NCDB); Cytoreductive Surgery
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6499-1

Purpose This study of a large, contemporary national database evaluated management patterns, outcomes, and prognostic factors of malignant peritoneal mesothelioma (MPM) in the USA. Methods The National Cancer Data Base was queried for newly diagnosed nonmetastatic MPM. Patients were divided into five cohorts: observation, chemotherapy alone, cytoreductive surgery (CRS) alone, CRS/chemo [referring to any non-hyperthermic intraperitoneal chemotherapy (HIPEC) chemotherapy], and CRS/HIPEC. Statistics included multivariable logistic regression, Kaplan–Meier analysis, and Cox proportional hazards modeling. Results Of 1514 patients, 379 (25%) underwent observation, 370 (24%) received chemotherapy only, 197 (13%) CRS alone, 352 (23%) CRS/chemo, and 216 (14%) CRS/HIPEC. No major temporal trends in management were noted. Factors predictive of CRS administration included younger age, female gender, insurance status, residence in educated areas, living farther from treating institutions, and treatment at academic centers ( p  < 0.05 for all). Compared with epithelioid histology, those with sarcomatoid and biphasic histology were less and more likely to undergo CRS, respectively ( p  < 0.05 for both). In all CRS patients, 30- and 90-day mortality rates were 0.8 and 1.2%, respectively. At median follow-up of 50 months, median OS in the respective groups was 6, 17, 21, 52, and 61 months ( p  < 0.001). Poor prognostic factors included advanced age, male gender, uninsured/Medicaid insurance, and sarcomatoid/biphasic histology ( p  < 0.05 for all). Conclusions In the USA, MPM is treated using a wide variety of strategies. Many factors impact the type of treatment delivered, including age, sociodemographics, geography, histology, and facility type. Although these data do not imply causation, combined-modality management seems associated with the longest OS.