Frequency of use and predictors of cancer-directed surgery in the management of malignant pleural mesothelioma in a community-based (Surveillance, Epidemiology, and End Results [SEER]) population Journal Article

  

Authors:	Flores, R. M.; Riedel, E.; Donington, J. S.; Alago, W.; Ihekweazu, U.; Krug, L.; Rosenzweig, K.; Adusumilli, P. S.; Carbone, M.; Pass, H. I.
Article Title:	Frequency of use and predictors of cancer-directed surgery in the management of malignant pleural mesothelioma in a community-based (Surveillance, Epidemiology, and End Results [SEER]) population
Abstract:	Introduction: Surgical intervention rates for mesothelioma patients treated at specialized tertiary hospitals are well more than 42%. Mesothelioma surgical strategies in the community are less well defined. This study evaluates the frequency of use and predictors of cancer-directed surgical intervention in a nontertiary-based population and the predictors for surgical intervention. Methods: The Surveillance, Epidemiology, and End Results database was searched from 1990 to 2004. Variables analyzed included age, sex, race, year of diagnosis, region, vital status, stage, surgery, and reasons for no surgery. The association of patient variables on receipt of cancer-directed surgery was evaluated using χ tests and logistic regression. The incidence of mesothelioma was also evaluated over this period of time. Results: Pathologically proven malignant pleural mesothelioma was identified in 1166 women and 4771 men. The rate of cancer-directed surgery was 22% (n = 1317). Significant predictors of receiving cancer-directed surgery included race, age, and stage (all p < 0.0001). A landmark analysis on the effect of cancer-directed surgery on survival after adjusting for patient and disease characteristics demonstrated a hazard ratio of 0.68 (p < 0.0001). The incidence rate of malignant pleural mesothelioma has remained constant. Conclusions: The rate of surgical intervention in the community is lower compared with tertiary referral centers. Age, stage, and race predict the likelihood of receiving cancer-directed surgery. A lower rate of cancer-directed surgery and worse overall outcome were observed in black patients. As part of quality assurance, referral of patients to centers with multidisciplinary programs that include thoracic surgical expertise should be considered. Copyright © 2010 by the International Association for the Study of Lung Cancer.
Keywords:	adolescent; adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; young adult; major clinical study; cancer radiotherapy; cancer staging; neoplasm staging; lung resection; incidence; age factors; time factors; health program; survival time; pleura mesothelioma; mesothelioma; seer program; tertiary health care; european continental ancestry group; lobectomy; malignant pleural mesothelioma; pleural neoplasms; african continental ancestry group; surveillance epidemiology and end results (seer); thoracic surgery; community-based participatory research
Journal Title:	Journal of Thoracic Oncology
Volume:	5
Issue:	10
ISSN:	1556-0864
Publisher:	Elsevier Inc.
Date Published:	2010-10-01
Start Page:	1649
End Page:	1654
Language:	English
DOI:	10.1097/JTO.0b013e3181f1903e
PUBMED:	20871264
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-77958180661&partnerID=40&md5=aa479d4e72ac34f44fa87322d230b71f
Notes:	--- - "Export Date: 20 April 2011" - "Source: Scopus"

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