BACKGROUND: The effects of surgery on the survival of patients with pleural mesothelioma remain poorly understood. We compared the therapeutic outcomes of patients receiving neoadjuvant chemotherapy followed by surgery or refusing surgery for pleural mesothelioma.
METHODS: This retrospective study included consecutive [ patients with pleural mesothelioma ] who were eligible for curative-intent surgery after three cycles of neoadjuvant chemotherapy with platinum plus pemetrexed at our hospital during January 2011–December 2021. Patients were divided into two groups. The surgery group comprised patients who underwent curative-intent surgery for pleural mesothelioma. The refusal of surgery group comprised patients who were medically eligible for surgery but refused to consent to surgery. Overall survival and progression-free survival were calculated using the Kaplan-Meier method with the generalized Wilcoxon test.
RESULTS: Of the 296 eligible patients for the study, 272 and 24 underwent and refused surgery, respectively. During the surgery, 204 (75.0%), 43 (15.8%), and 25 (9.2%) patients underwent pleurectomy/decortication, extrapleural pneumonectomy, and exploratory thoracotomy, respectively. The median follow-up length was 28.4 months. The median overall survival periods were 40.7 (95% confidence interval [CI]: 32.2-–45.6) and 23.6 (95% CI: 15.2–43.0) months for surgery and refusal of surgery, respectively (P = 0.03). The median progression-free survival periods were 20.2 (95% CI: 17.0–22.5) and 12.9 (95% CI: 8.3–16.8) months for surgery and refusal of surgery, respectively (P < 0.001).
CONCLUSIONS: Overall survival and progression-free survival were significantly better in surgery than in refusal of surgery. Surgery may improve the survival outcomes of patients with pleural mesothelioma
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