Impact of Operation on Disease Progression and Survival of Patients With Pleural Mesothelioma

Akifumi Nakamura; Masaki Hashimoto; Ayumi Kuroda; Seiji Matsumoto; Nobuyuki Kondo; Kazuhiro Kitajima; Toshiyuki Minami; Kozo Kuribayashi; Takashi Kijima; Seiki Hasegawa

doi:10.1016/j.athoracsur.2024.02.022

Impact of Operation on Disease Progression and Survival of Patients With Pleural Mesothelioma

Ann Thorac Surg. 2024 Feb 28:S0003-4975(24)00126-7. doi: 10.1016/j.athoracsur.2024.02.022. Online ahead of print.

Authors

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, Hyogo, Japan. Electronic address: xxmp97511@zeus.eonet.ne.jp.
² Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, Hyogo, Japan.
³ Department of Radiology, Hyogo Medical University, Hyogo, Japan.
⁴ Division of Respiratory Medicine and Hematology, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.

PMID: 38428631
DOI: 10.1016/j.athoracsur.2024.02.022

Abstract

Background: The effects of surgery on the survival of patients with pleural mesothelioma remain poorly understood. We compared the therapeutic outcomes of patients receiving neoadjuvant chemotherapy, followed by surgery or refusing surgery, for pleural mesothelioma.

Methods: This retrospective study included consecutive patients who were eligible for curative-intent surgery after 3 cycles of neoadjuvant chemotherapy with platinum plus pemetrexed at our hospital during January 2011 to December 2021. Patients were divided into 2 groups. The surgery group comprised patients who underwent curative-intent surgery for pleural mesothelioma. The refusal-of-surgery group comprised patients who were medically eligible for surgery but refused to consent to surgery. Overall survival and progression-free survival were calculated using the Kaplan-Meier method with the generalized Wilcoxon test.

Results: Of the 296 eligible patients for the study, 272 underwent surgery and 24 refused surgery. During the surgery, 204 patients (75.0%), 43 (15.8%), and 25 (9.2%) underwent pleurectomy/decortication, extrapleural pneumonectomy, and exploratory thoracotomy, respectively. The median follow-up length was 28.4 months. The median overall survival periods were 40.7 months (95% CI, 32.2-45.6 months) for surgery and 23.6 months (95% CI, 15.2-43.0 months) for refusal of surgery (P = .03). The median progression-free survival periods were 20.2 months (95% CI, 17.0-22.5 months) for surgery and 12.9 months (95% CI, 8.3-16.8 months) for refusal of surgery (P < .001).

Conclusions: Overall survival and progression-free survival were significantly better in surgery than in refusal of surgery. Surgery may improve the survival outcomes of patients with pleural mesothelioma.