Work

F-028predictors of Trimodality Therapy and Trends in Therapy for Malignant Pleural Mesothelioma

Year: 2017

Type: article

Abstract: Objectives: Malignant pleural mesothelioma (MPM) is a rare malignancy that is usually fatal, with much controversy and heterogeneity regarding treatment strategies. Our goal was to identify the practice patterns of MPM in the United States. Methods: Patients with histologically proven MPM were identified within the National Cancer Data Base (2004-2014). Predictors of trimodality therapy were analysed by multivariate logistic regression using available clinical and demographic data. Time-trend analysis was evaluated using Somer’s D association test. Results: Twenty thousand, five hundred and sixty-one patients met the inclusion criteria. Complete clinical staging information was available for 15,150 patients: stage I (n = 3400, 22%), stage 2 (n = 2146, 14%), stage 3 (n = 3137, 21%), and stage 4 (n = 6467, 43%). Only 3,282 (16%) underwent cancer-directed surgery, among whom only 533 (2.59%) had trimodality therapy. Patients undergoing trimodality therapy were more likely to be treated at an academic centre (OR 1.9, 95% CI 1.1–3.0), less likely to be treated in the South (OR 0.37, 95% CI 0.24–0.58), more likely to travel >25 miles to the treatment facility (OR 1.9, 95% CI 1.4–2.6), more likely to be in the upper income quartile (OR 1.4, 95% CI 1.0–2.0), less likely to be greater than 70 years of age (OR 0.22, 95% 0.13–0.36), and less likely to have a Charlson comorbidity score of 1 or greater (OR 0.60, 95% CI 0.47–0.77), with no significant difference by race, gender, or insurance status. Over the 10 years study period there was an increase in patients who underwent cancer-directed surgery and surgery with chemotherapy, whereas the proportion undergoing surgery with radiation therapy decreased. Conclusions: Many patients with MPM are not treated with aggressive therapy, with significant variation in treatment patterns. Referrals to high volume and specialized centres may help offer more therapeutic options and trial or registry enrolment. Disclosure: No significant relationships.

Source: Interactive Cardiovascular and Thoracic Surgery

DOI: 10.1093/icvts/ivx280.028