Aggressive surgery at a specialty center could more than double the survival period of a patient diagnosed today with malignant pleural mesothelioma.
Surgery may buy precious time.
Although oncologists and patients often advise and opt against it, surgery remains an effective tool that significantly extends lives, according to an analysis of 14,228 mesothelioma patients across the U.S. The sample of patients is among the largest in similar studies.
“There are limitations to the data, but people just do better with surgery,” thoracic surgeon Andrea Wolf, of Mount Sinai Medical Center in New York City, told Asbestos.com. “No matter how you slice it, surgery seems to improve survival.”
The analysis revealed a median survival of 14.5 months for patients who had surgery but 6.5 months for those who did not. There was a five-year survival rate of 15 percent for those who underwent surgery and less than 1 percent for those who did not.
Only 23 percent of the patients in the analysis had surgery. The sampling was taken from 1973-2009 as part of the Surveillance, Epidemiology and End Results (SEER) database. PLOS One, a multidisciplinary Open Access Scientific Journal, published the Mount Sinai Medical staff analysis in December 2015.
SEER Cancer Database Is All-Inclusive
The SEER database includes a wide sampling of unselected cancer patients who share pleural mesothelioma tumor characteristics at diagnosis. All cell types of mesothelioma were used in the analysis.
- Total and partial resections
- Extrapleural pneumonectomies
- Pleurectomy/decortication procedures
The analysis confirmed the advantage of surgery on survival was not because of differences in patient characteristics among those who had surgery, but it was based on a propensity score analysis adjusted for age, sex and stage of disease.
“For people who say there is no role for surgery [with mesothelioma], this argues against that,” Wolf said. “This was not a carefully selected subset of patients. This was everyone. You tend to think now that surgery really makes a difference.”
Although significant progress in treating mesothelioma has been made in the last few years, the SEER data analysis did not reflect it. There was no marked difference in survival times between the 1973-1999 and 2000-2009 periods.
The median age at diagnosis was 62, more than half of the cases were diagnosed with distant metastases, and three-quarters of the patients were male.
Within a multivariable analysis, younger age, early stage, female gender, epithelial histology and treatment with surgery are independent predictors of longer survival.
Hope Still Abounds for People with Mesothelioma
“There is absolutely hope for these people today,” Wolf said. “There are treatment options, and there is reason for hope. I can’t tell you how many people I see who were told elsewhere, ‘Just get your affairs in order. There is nothing we can do.’ The fact is, people can survive with this disease if treated correctly.”
Wolf tells a story about a patient who came to her with advanced-stage disease. He had been told he had six months to live and nothing really could be done for him.
He came under her care and had surgery. Four years later, she watched him proudly walk his daughter down the aisle on her wedding day.
“There are patients out there who seem to have everything working against them, advanced age, advanced disease, biphasic cell type, but they just keep going and the therapy works,” she said. “Every patient is different. You give them the benefit of the doubt. People can do well.”