Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma

Abstract

Introduction/Background Although malignant pleural mesothelioma (MPM) is generally a disease associated with more advanced age, the association of age, treatment, and outcomes has not been well-characterized. We evaluated the impact of age on outcomes in MPM patients to provide data for use in the treatment selection process for elderly patients with potentially resectable disease. Patients & Methods Overall survival (OS) of patients younger than 70 and 70 years or older with Stage I–III MPM who underwent cancer-directed surgery or non-operative management in the Surveillance, Epidemiology, and End Results database (2004–2010) was evaluated using multivariable Cox proportional hazard models and propensity score-matched analysis. Results Cancer-directed surgery was used in 284 of 879 (32%) patients who met inclusion criteria, and was associated with improved OS in multivariable analysis (hazard ratio 0.71, p=0.001). Cancer-directed surgery was used much less commonly in patients 70 and older compared to patients younger than 70 (22% [109/497] versus 46% [175/382], p<0.001), but patients 70 and older had improved 1-year (59.4% versus 37.9%) and 3-year (15.4% versus 8.0%) OS compared to non-operative management. The benefit of surgery in patients 70 and older was observed even after propensity score-matched analysis was used to control for selection bias. Conclusion Surgical treatment is associated with improved survival compared to non-operative management for both patients younger than 70 years and patients age 70 years or older.

Survival analysis via nomogram of surgical patients with malignant pleural mesothelioma in the Surveillance, Epidemiology, and End Results database

“…In accordance with previous reports, we also found that advanced age was a significant factor associated with poor survival . Furthermore, we found that the age at diagnosis had nonlinear effects on the log of the hazard ratio of OS, which has not previously been reported in MPM.…”

“…These data are similar to our finding of 14 months median OS, thus supporting our opinion that the prognosis of surgically treated MPM patients should be analyzed separately from non‐surgery patients. In a study by Yang et al based on a SEER dataset, the survival rate in surgically treated patients was higher than that in our data (1‐year survival 63% vs. 53.9%; 3‐year survival 21% vs. 17.1%) . This may be because Yang et al excluded patients with sarcomatoid histology and stage IV disease.…”

“…Furthermore, we found that the age at diagnosis had nonlinear effects on the log of the hazard ratio of OS, which has not previously been reported in MPM. In a Cox proportional hazards survival model constructed by Yang et al , surgery was associated with improved survival in patients aged ≥ 70 years but not in those aged ≥ 80 . Consistent with this result, our nomogram also showed that the mortality risk rises sharply with the increase in age in patients aged > 70.…”

“…There have been several studies of survival involving a SEER dataset of MPM patients . Taioli et al reported median survival of 6.5 months in patients who were not administered radiotherapy or surgery, 14.5 months in the surgical group, and 13 months in patients administered both radiation and surgery .…”

“…Recently Wang et al built a nomogram based on data from the United States National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to predict the prognosis of patients with MPM, but this effort was complicated by the fact that the outcomes of patients treated with and without surgery differed significantly . In selected patients, surgery can lead to significantly better survival compared to non‐surgical therapy (18 vs. 12 months) .…”