Upfront Surgery Improves Outcomes Over Neoadjuvant Chemotherapy in Resectable Mesothelioma

Abstract

Objective Recent release of MARS2 study compared outcomes after (extended) pleurectomy decortication plus chemotherapy versus chemotherapy alone. The results showed (extended) pleurectomy decortication group with worse survival, a higher rate of serious adverse events and poorer quality of life.1 This study however included all cell types and the surgical group included about 2.6 times as many sarcomatoid patients as the chemotherapy group. We aimed to evaluate the effects of upfront chemotherapy or surgery whilst maintaining macroscopic complete resection (MCR) as the treatment of choice for MPM in epithelioid 'resectable' mesothelioma. Methods Consecutive of series of 137 patients 109M: 24F, median age 67(41-79) years] with epithelioid resectable mesothelioma underwent radical surgery for MPM. We identified 92 patients 77M:15F, median age 67(41-79) years], in whom received upfront chemotherapy and compared their perioperative outcomes this with 45 patients 32M:13F, median age 68 (45-79) years] who received upfront surgery. Results There was no significant intergroup difference in demographics or pathological stage (TNM 8th) (p=0.32). However, there were significantly more non-epithelioid cases after surgery in those who received neoadjuvant chemotherapy (p=0.01). In overall survival (OS) between the two groups, upfront surgery group (40.57 months in stage I/II, 25.26 months in stage III) had better outcomes than upfront chemotherapy group (20.93 months in stage I/II, 14.88 months in stage III) (p=0.011). (Figure 1) Conclusion Upfront surgery in epithelioid resectable MPM is associated with improved perioperative outcomes and improved overall survival. (Figure Presented).