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C. Casadio



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    O22 - Mesothelioma III (ID 122)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 1
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      O22.07 - Does surgery improve survival of patients with malignant pleural mesothelioma? A multicenter retrospective analysis of 1365 consecutive patients. (ID 2962)

      17:20 - 17:30  |  Author(s): C. Casadio

      • Abstract
      • Presentation
      • Slides

      Background
      Medical management of malignant pleural mesothelioma (MPM) has obtained a moderate survival improvement over the years, while surgery with pleurectomy / decortication (P/D) or extrapleural pneumonectomy (EPP) can be an option for selected patients with resectable disease. The aim of this study was to investigate the impact of surgical treatment on the outcome of patients with MPM.

      Methods
      We retrospectively reviewed data from 1365 consecutive patients with histologically proven MPM, treated from 1982 to 2012 in six Institutions.Patients received either chemotherapy alone (n=172) or best supportive care (n=690) or surgical treatment (n=503), by either P/D (n=202) or EPP (n=301) with or without chemotherapy. All patients were followed up until death or for a minimum period of one year. The cox proportional hazards regression model was used to estimate relative improvements and to test the statistical hypothesis; a p-value less than 0.05 was considerd statistical significant.

      Results
      Figure 1 Figure1. Kaplan-Meier survival curves according to the treatment (non surgical treatment vs EPP vs P/D) considering only patients with independent good prognostic factors After a median follow-up of 6.7 years (range 1.1-14.8), 230 (16.8%) patients were alive; median survival for patients who received palliative treatment or chemotherapy alone, P/D and EPP groups were 11.7 (95%CI: 10.5-12.5) months, 20.5 (95%CI: 18.2-23.1) months, and 18.8 (95%CI: 17.2-20.9) months, respectively. Testing the hypothesis of equal survival distributions the statistical significance was reached for the P/D and EPP groups versus non surgical treatment group (p <0.001) but not for the EPP versus P/D groups (p=0.885). The 30 day mortality was 2.6% after P/D and 4.1% after EPP (p=0.401). According to multivariate analysis (n=1227) age < 70, epithelial histology and chemotherapy were independent favourable prognostic factors. In the subset of 312 (25.4%) patients with all favourable prognostic factors median survival was 15.5 months after medical therapy alone, 19.4 months after P/D, and 18.7 months after EPP (Figure 1). A risk reduction of 31% (95%CI: 14-45%) for the P/D group and of 23% (95%CI: 7-36%) for the EPP group was observed compared to the medical treatment group.

      Conclusion
      Our data suggest that patients with good prognostic factors had a similar survival whether they received medical therapy only, P/D or EPP. The modest benefit observed after surgery over medical treatment requires further investigation, and a large multicenter randomized trial, testing P/D after induction chemotherapy versus chemotherapy alone in MPM patients with good prognostic factors, is needed.

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    P3.14 - Poster Session 3 - Mesothelioma (ID 197)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Mesothelioma
    • Presentations: 1
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      P3.14-009 - High resolution study on survival of pleural mesothelioma from the records of the Piedmont Registry of Malignant Mesotheliomas - report on incident cases 2008-2009 (ID 2302)

      09:30 - 09:30  |  Author(s): C. Casadio

      • Abstract

      Background
      The legacy of occupational and environmental asbestos exposure in Piedmont, Italy, is a continuing epidemic of pleural malignant mesothelioma (MPM). MPM still entails a poor prognosis, but progresses in its medical and surgical treatment have occurred and guidelines started to appear. We aimed to assess: (i) the appropriateness of treatment for MPM cases recently diagnosed in the Piedmont population, taking into account patients’ general conditions and disease stage at diagnosis, (ii) the end results of treatment.

      Methods
      We exploited the Registry of Malignant Mesotheliomas (RMM) records to identify incident cases from 2008 to 2011. Patients diagnosed/treated in hospitals including a thoracic surgery unit and in the Casale Monferrato hospital were known to represent about 70% of all MPM incident cases and were included in this study, as for them not only clinical records on diagnostic procedures, but also on treatment and follow-up were completely retrieved by RMM. Vital status at 31/12/2012 was ascertained for all MPM cases. Current analyses were limited to incident cases 2008-2009, followed at least up to 3 years. Multinomial logistic regression was used to estimate the odds ratio (OR) of receiving a specific treatment (categories: cytoreductive surgery, CRS, chemo/immunotherapy, CIT, best supportive care, BSC), conditional on individual characteristics. Survival was assessed with univariate (Kaplan-Meier) and multivariate (Cox) methods.

      Results
      There were 297 MPM cases. Taking CIT as reference, the OR of receiving CRS was decreased by older age and low performance status (Table 1). That of receiving BSC alone was increased by older age and low performance status as well, and by non-epithelial histotype. Median survival was 13.6 months for patients receiving CIT and 18.3 for those undergoing CRS Figure 1

      Conclusion
      In participating centres, MPM are currently treated in agreement with available guidelines, and treatment outcomes are consistent with expectations.