Ann Surg Oncol. 2014 May 20. [Epub ahead of print]

Current Trends in the Management of Malignant Peritoneal Mesothelioma.

Miura JT1, Johnston FM, Gamblin TC, Turaga KK.

Author information

• 1Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

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 peritonealmesothelioma 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.