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J Thorac Oncol. 2017 Nov;12(11):1704-1714. doi: 10.1016/j.jtho.2017.08.012. Epub 2017 Aug 24.

National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma.

Author information

1
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
2
Oncora Medical, Philadelphia, Pennsylvania.
3
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
4
Department of Surgery, Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland.
5
Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: charlessimone@umm.edu.

Abstract

INTRODUCTION:

Controversy exists regarding the optimal surgical technique for malignant pleural mesothelioma (MPM). We evaluated national practice patterns and outcomes of MPM treated with extrapleural pneumonectomy (EPP) versus lung-sparing extended pleurectomy/decortication (P/D).

METHODS:

The National Cancer Database was queried for patients with newly diagnosed MPM undergoing EPP or P/D. Multivariable logistic regression ascertained clinical factors independently associated with P/D receipt. Kaplan-Meier analysis was used to evaluate overall survival (OS) between cohorts; multivariable Cox proportional hazards modeling was used to evaluate factors associated with OS. Survival was then evaluated between propensity-matched populations.

RESULTS:

Overall, 1307 patients (271 undergoing EPP [21%] and 1036 undergoing P/D [79%]) met the criteria. Patients receiving P/D were older (p = 0.028), whereas those undergoing EPP were more likely to live in a rural area (p = 0.044), live farther from the treating facility (p = 0.039), and receive treatment at an academic center (p = 0.050). There were no differences between cohorts in 30-day readmission or mortality (all p > 0.05). The median OS times in the EPP and P/D groups were 19 versus 16 months, respectively (p = 0.120); no differences were observed after propensity matching (p = 0.540).

CONCLUSIONS:

In this largest analysis of its kind to date, findings from this contemporary cohort demonstrate that P/D comprised most surgical procedures for MPM. Procedure type was influenced by sociodemographic and geographical factors, without observed differences in survival or postoperative mortality and readmission rates between techniques.

KEYWORDS:

Mesothelioma; Pleurectomy; Pneumonectomy; Radiation therapy; Surgery

PMID:
28843362
DOI:
10.1016/j.jtho.2017.08.012
[Indexed for MEDLINE]

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