Efficacy of Perioperative Platinum-Pemetrexed Chemotherapy Combined With Pleurectomy/Decortication for Pleural Mesothelioma.

Abstract

The optimal timing of chemotherapy in multimodal treatment of pleural mesothelioma remains unclear. This study evaluated the efficacy of adjuvant chemotherapy (AC) after neoadjuvant chemotherapy (NAC) with platinum and pemetrexed combined with pleurectomy/decortication. We retrospectively reviewed patients with resectable pleural mesothelioma who underwent NAC followed by pleurectomy/decortication with macroscopic complete resection between January 2012 and December 2024. Patients were assigned to AC and non-AC groups. After 1:1 propensity score matching, landmark analyses using 30 days after surgery as the landmark time point were performed to minimize immortal time bias. Disease-free survival and overall survival were analyzed by the Kaplan-Meier method and Cox proportional hazards models. Subgroup analyses were performed to identify populations benefiting from AC. Of 275 patients who achieved macroscopic complete resection, 273 were analyzed after exclusion of two 30-day postoperative deaths; 196 received AC, and 77 did not. After matching and a median follow-up of 35.5 months, the AC group showed significantly longer disease-free survival (median, 16.0 vs 11.2 months; hazard ratio, 0.57; 95% CI, 0.39-0.83; P = .0034) and overall survival (median, 51.6 vs 23.0 months; hazard ratio, 0.49; 95% CI, 0.30-0.78; P = .0028). Subgroup analyses suggested greater disease-free survival benefit in patients with nodal involvement (ypN1 vs ypN0) and ypStage IB or higher disease (eighth edition). Postoperative AC after NAC and pleurectomy/decortication may improve survival in pleural mesothelioma, particularly in patients with ypStage IB or higher disease.