Mesothelioma Surgery Improves Long-Term Survival Rates, Study Finds

Mesothelioma is a deadly form of cancer caused by exposure to asbestos, which is usually at a very advanced stage by the time it is diagnosed. However, the findings of new research suggests that mesothelioma long-term survival rates are higher among individuals who undergo both chemotherapy and surgery.

A researcher from the University of Miami, Dr. Ahmed Alnajar, presented the findings of a new study at the 2021 World Conference on Lung Cancer on September 8, indicating that the addition of surgery to chemotherapy in the treatment of mesothelioma could quadruple the number of patients who survived ten years or longer with the disease. The findings are considered preliminary until published in a peer reviewed journal.

Individuals diagnosed with the invasive lung cancer typically have a very short life expectancy, since it can be decades between the exposure to asbestos and progression of the disease to the point that mesothelioma is diagnosed. While there are treatments, such as chemotherapy and surgery, there is no cure for mesothelioma, and it remains one of the most deadly forms of cancer, although it is rare.

Surgical interventions for mesothelioma are controversial, since it may only extend a patient’s life for a short period of time. However, surgery is often done to provide patients reduced pain and discomfort. Procedures often include draining fluid from around the lungs or removing fluid from around the heart or abdominal cavity.

During surgery, doctors can also attempt to remove tumors growing throughout the body or removing the entire lung where the cancer is found. Other surgical techniques include removing the pleura, or the sacs that line the lungs. Approaches can also focus on removing various parts of the abdomen, such as the lining of fatty tissue or the lining of the abdomen, if the cancer has spread to those areas.

To test the effectiveness of these surgical techniques, Alnajar used data from the National Cancer Database including patients with clinical stage I to IIIA malignant pleural mesothelioma who underwent chemotherapy from 2004 to 2017. In addition, some patients also underwent surgery while others did not.

Overall, the study included more than 4,000 patients who received chemotherapy, about 1,800 of whom also underwent surgery.

The data indicates patients who had both chemotherapy and surgery lived an average of six months longer. Those that underwent chemotherapy only had a 16-month survival estimate, compared to 22 months for the patients in the combination therapy group.

The five-year survival estimates for the chemotherapy only group was 11% compared to 24% for the combination group. The 10-year survival estimates for the chemotherapy only group was 4% compared to 14% for the chemotherapy plus surgery group.

Twice as many patients were still alive at five years with surgery and four times as many lived 10 years or longer if they underwent surgery. While the survival rates are much better with surgery, the long-term survival remained poor with or without surgery.

The findings contradict a study published ten years ago, the Mesothelioma and Radical Surgery study, which showed not only that surgery did not improve survival outcomes for patients, but increased the risk of death. The findings of this new study, however, indicates surgery plus chemotherapy provides patients with a “survival advantage.”

“The addition of curative intent surgery to multiagent chemotherapy is associated with a survival advantage in this large nationwide database study,” Alnajar concluded. “Results of well-designed randomized controlled trials are needed to further define the role of curative intent surgery in the treatment algorithm for malignant pleural mesothelioma.”