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Role of postoperative radiotherapy in the management of malignant pleural mesothelioma

A propensity score matching of the SEER database

Bedeutung der postoperativen Strahlentherapie bei der Behandlung des malignen Pleuramesothelioms

„Propensity score matching“ der SEER-Datenbank

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Abstract

Introduction

This study assessed the prognostic impact of postoperative radiotherapy in patients with surgically resected malignant pleural mesothelioma (MPM).

Methods

MPM patients diagnosed between 2000 and 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. A propensity-matched analysis was performed considering baseline characteristics (age, gender, race, histology, TNM stage, and type of surgery).

Results

A total of 2166 patients were identified. The median age was 60 years (range 25–85 years), and 469 patients received postoperative radiotherapy. Both before and after propensity score matching, overall survival (P < 0.0001 and P = 0.012, respectively) was better in the postoperative radiotherapy group. When the overall survival was stratified by histology, postoperative radiotherapy did not improve the survival in sarcomatoid histology patients both before and after matching (P = 0.424 and P = 0.281, respectively). In multivariate analysis of the matched population, not receiving postoperative radiotherapy did not correlate with worse survival (hazard ratio: 1.175; P = 0.12). Factors associated with worse survival include sarcomatoid histology, nodal positivity, and age ≥70.

Conclusion

Evidence from this analysis is insufficient on its own to routinely recommend postoperative radiotherapy for surgically resected MPM. However, large-scale prospective clinical trials are warranted to further evaluate this intervention in nonsarcomatoid histology.

Zusammenfassung

Hintergrund

In der vorliegenden Studie wurde der prognostische Einfluss der postoperativen Strahlentherapie bei Patienten mit chirurgisch reseziertem malignem Pleuramesotheliom (MPM) untersucht.

Methoden

In der SEER-Datenbank (Surveillance, Epidemiology, and End Results) wurden Patienten ermittelt, bei denen zwischen 2000 und 2013 die Diagnose eines MPM gestellt worden war. Unter Berücksichtigung der Ausgangsmerkmale (Alter, Geschlecht, Ethnizität, Histologie, TNM-Stadium und Art des chirurgischen Eingriffs) wurde eine Vergleichsgruppenanalyse („propensity-matched analysis“) durchgeführt.

Ergebnisse

Es wurden insgesamt 2166 entsprechende Patienten ermittelt. Das Durchschnittsalter betrug 60 Jahre (Spanne: 25–85 Jahre), bei 469 Patienten erfolgte eine postoperative Strahlentherapie. Sowohl vor als auch nach dem „propensity score matching“ war das Gesamtüberleben (p < 0,0001 bzw. p = 0,012) in der Gruppe mit postoperativer Strahlentherapie besser. Bei Stratifizierung des Gesamtüberlebens gemäß der Histologie führt die postoperative Strahlentherapie vor und nach dem Matching nicht zu einer Verbesserung des Überlebens bei Patienten mit sarkomatoider Histologie (p = 0,424 bzw. p = 0,281). In der multivariaten Analyse der gematchten Population war der Nichterhalt einer postoperativen Strahlentherapie nicht mit einem schlechteren Überleben korreliert (Hazard-Ratio: 1,175; p = 0,12). Zu den Faktoren, die mit einem schlechteren Überleben vergesellschaftet waren, gehörten eine sarkomatoide Histologie, nodale Positivität und ein Alter ≥70 Jahre.

Schlussfolgerung

Die Evidenz der vorliegenden Auswertung an sich ist unzureichend, daher kann die postoperative Strahlentherapie bei chirurgisch entferntem MPM nicht routinemäßig empfohlen werden. Prospektive klinische Studien von großem Umfang sind erforderlich, um diese Intervention bei nichtsarkomatoider Histologie näher zu untersuchen.

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Funding

This study has not been funded.

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Authors and Affiliations

  1. Clinical Oncology department, Faculty of medicine, Ain Shams University, Cairo, Egypt

    Omar Abdel-Rahman

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  1. Omar Abdel-Rahman
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Corresponding author

Correspondence to Omar Abdel-Rahman.

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Conflict of interest

O. Abdel-Rahman declares that he has no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Caption Electronic Supplementary Material

66_2016_1092_MOESM1_ESM.jpg

Supplemental Fig. 1: Kaplan–Meier curve of overall survival according to whether or not postoperative radiation therapy has been given in the two histological subtypes: a nonsarcomatoid, b sarcomatoid.

66_2016_1092_MOESM2_ESM.jpg

Supplemental Fig. 2: Kaplan–Meier curve of cancer-specific survival according to whether or not postoperative radiation therapy has been given in the matched population (after propensity score matching).

Supplemental Fig. 3: Cancer-specific survival in the postmatching population

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Abdel-Rahman, O. Role of postoperative radiotherapy in the management of malignant pleural mesothelioma. Strahlenther Onkol 193, 276–284 (2017). https://doi.org/10.1007/s00066-016-1092-7

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  • DOI: https://doi.org/10.1007/s00066-016-1092-7

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