Comparison of surgical treatment and systemic chemotherapy in patients with non-epithelioid malignant pleural mesothelioma

Objective: This study aimed to investigate the most appropriate treatment options for patients with non-epithelioid malignant pleural mesothelioma.

Methods: We retrospectively analyzed patients with non-epithelioid malignant pleural mesothelioma who received treatment at our center.

Results: Forty-two patients were included in this study. Hyperthermic intrathoracic chemotherapy (HITHOT) was performed in 20 (47.6 %) patients. There were 20 (47.6 %) patients in the macroscopic complete resection (MCR) group and 22 (52.4 %) patients in the non-MCR group. The median overall survival (mOS) of patients in the MCR group was 16 (95 % CI,7.2-24.8) months, and the mOS of patients in the non-MCR group was 6 (95 % CI,2.9-9.1) months (p = 0.001). The mOS of patients who underwent HITHOT was 12 (95%CI,5.4-18.6) months, and the mOS of non-HITHOT patents was 6 (95%CI,2.6-9.4) months (p = 0.007). The mOS of patients who did and did not undergo the HITHOT in the MCR group was 21 and 15 months, respectively (p = 0.161). The mOS of biphasic subtype patients was 11 (95%CI,6.8-15.2) months and sarcomatoid subtype patients was 6 (95%CI,3.1-8.9) months (p = 0.179). In the OS analysis, performing MCR (p = 0.003), applying HITHOT (p = 0.012), TNM stage (p = 0.006), and receiving adjuvant chemotherapy (p = 0.001) were found to be significant factors. In the multivariate analysis for OS, the HITHOT application was found to be a significant parameter (p = 0.035).

Conclusions: The mOS of patients who achieved MCR in non-epithelioid malignant pleural mesothelioma was better than that of patients who did not achieve MCR. However, the OS of patients who underwent the HITHOT was better than that of patients who did not.