Elderly Patients with Malignant Pleural Mesothelioma May Benefit from Surgery

Elderly Patients with Malignant Pleural Mesothelioma May Benefit from Surgery

Surgery improves overall survival in patients with malignant pleural mesothelioma, even among elderly patients, according to the results of the study, “Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma,” published in Clinical Lung Cancer.

Malignant pleural mesothelioma (MPM) is a highly aggressive cancer with a relatively poor prognosis and median survival. Owing to its long latent stage, 58 percent of patients with MPM are over the age of 70 when the disease is diagnosed, a number that is increasing worldwide. But whether surgery is a viable option for patients in this age group has not been established.

“Quantitative data to support difficult treatment decisions about when to offer surgery for elderly MPM patients are needed, as a subset of these patients with favorable prognostic factors may experience extended survival by undergoing cancer-directed surgery,” Chi-Fu Jeffrey Yang, MD, Duke University Medical Center, wrote in the report.

Yang and colleagues used the Surveillance, Epidemiology, and End Results database (2004–10) to examine overall survival (OS) in patients, younger and older than 70 years of age, with Stage I to III MPM, who either underwent surgery or were placed on nonoperative management. Cancer-directed surgery was used in 284 of 879 (32%) patients who met the study’s inclusion criteria.

Surgical patients tended to be younger than those who received nonoperative management (median age, 67 years versus 74 years).  Results found a higher, 30-day mortality rate in the nonoperative group compared those given surgery (11.7% versus 4.3%).

Cancer-directed surgery was significantly less commonly in patients who were 70 years and older, compared to those under age 70 (22% versus 46%). Importantly, however, patients 70 and older had improved one-year (59.4% versus 37.9%) and three-year (15.4% versus 8.0%) overall survival when compared to the nonoperative management group.

Surgery did not confer a survival benefit to patients older than age 80.

“Future research should focus on evaluating the comorbidities and characteristics that are most important in the elderly population to optimize both perioperative outcomes and long-term survival,” Yang and colleagues wrote.

The researchers acknowledged the study was limited by the lack of information regarding patient comorbidities, socioeconomic status, chemotherapy regimens, details regarding the operation, and details regarding clinical and pathologic staging.

“While these results cannot be used to show definitive benefit to surgery in all elderly patients, the analysis does suggest that advanced age alone should not be used as an absolute contraindication to surgery,” Yang and colleagues wrote. “Even elderly patients should go through a multidisciplinary evaluation to decide if surgery should be part of their treatment regimen.”

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