# Effectiveness of Surgical Treatment on Survival of Patients with Malignant Pleural Mesothelioma

## TL;DR

Surgery, especially pleurectomy/decortication, improves survival in patients with malignant pleural mesothelioma compared to chemotherapy alone.

## Contribution

This study provides evidence that surgical treatment, particularly PD, significantly enhances long-term survival in selected MPM patients.

## Key findings

- Patients who underwent surgery had a 53% five-year survival rate, compared to 23% for those treated with chemotherapy alone.
- Pleurectomy/decortication (PD) resulted in a 67% five-year survival rate, outperforming extrapleural pneumonectomy (EPP) at 40%.
- Surgery was associated with a 66% lower risk of death after adjusting for clinical factors.

## Abstract

The role of surgery in treating malignant pleural mesothelioma (MPM) remains debated due to limited evidence from clinical trials. In this study, we examined long-term survival in patients with MPM who received surgery combined with neoadjuvant chemotherapy compared to those treated with chemotherapy alone. Of the 122 patients, only 16 underwent surgery; eight received pleurectomy/decortication (PD), and eight had extrapleural pneumonectomy (EPP). At five years, the survival rate was higher in the surgery group (53%) than in the chemotherapy-only group (23%). Patients treated with PD achieved the best outcomes, with a five-year survival rate of 67%, compared to 40% for EPP. After adjusting for relevant clinical factors, surgery was linked to a significantly lower risk of death. These findings suggest that surgical treatment, especially PD, can improve survival in selected patients with MPM.

Background: The benefit of surgery for malignant pleural mesothelioma is highly debated, as few robust clinical trials show its effectiveness. Objective: To examine the long-term survival of patients with malignant pleural mesothelioma who underwent surgical treatment combined with neoadjuvant chemotherapy versus those who received chemotherapy alone. Methods: We analyzed a historical cohort of 122 patients diagnosed with mesothelioma, confirmed through histopathological examination. We compared the clinical and laboratory characteristics of the surgery and chemotherapy groups at baseline. We calculated Kaplan–Meier survival curves and used Cox’s proportional hazards model to evaluate the relationship between surgery and mortality. Results: Surgery was performed in 16 out of 122 cases. Pleurectomy/decortication (PD) represented 8 cases, while extrapleural pneumonectomy (EPP) accounted for the remaining 8 cases. At five years, survival rates for those who underwent surgery compared to chemotherapy alone were 53% (95% CI 15–81%) versus 23% (95% CI 10–40%), respectively. Survival among those who had PD was 67%, compared to 40% for those who had EPP. Surgical treatment was associated with improved survival, with a hazard ratio (HR) of 0.34 (95% CI 0.19–0.61) after adjusting for factors such as age over 65, the duration from symptom onset to diagnosis, hemoglobin levels below 10 g, a neutrophil-to-lymphocyte ratio over 6, and ECOG scores greater than 2. Conclusions: Mesothelioma surgery, whether it be PD or EPP, enhances patients’ survival compared to chemotherapy. PD produces better outcomes than EPP.