Current trends in the management of malignant peritoneal mesothelioma.

Abstract

Historically, malignant peritoneal mesothelioma (MPM) has been considered an aggressive and lethal neoplasm. However, contemporary series have demonstrated improved outcomes following a combination of cytoreductive surgery and intraperitoneal chemotherapy. We sought to assess the trends in management and survival of patients with MPM in the United States. The Surveillance, Epidemiology, and End Results database was used to identify all patients diagnosed with malignant peritoneal mesothelioma from 1973 to 2010. Overall survival (OS) was studied with Kaplan-Meier curves and Cox regression analyses. We identified 1,591 patients with MPM. Median age at diagnosis was 64 years (IQR 53-74 years) with the majority of patients presenting with metastatic disease (n = 962, 60.5 %). A total of 980 patients (61.6 %) did not receive surgical therapy. Receipt of radical cytoreduction for patients with metastatic MPM demonstrated a significant improvement in OS compared with patients not receiving surgery (20 vs. 4 months, p < 0.01). A temporal increase was observed in OS for patients receiving surgery (1991-1995: 15 vs. 2006-2010: 38 months, p = 0.1). In multivariate models, limited (HR 0.55; 95 % CI 0.48-0.63; p < 0.01) and radical (HR 0.66; 95 % CI 0.54-0.80; p < 0.01) surgery were independently associated with improved survival. In the current era, approximately three of every five patients do not receive surgery when diagnosed with MPM, although a significant survival benefit is noted in select patients. The opportunity to improve patient survival with surgical therapy is lost in a significant number of MPM patients.