Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals

Our plain-English summary of Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals, by V.M. Welten, A.C. Fields, R.A. Malizia, et al (Journal of Gastrointestinal Surgery, 2022).

The study

• Authors: V.M. Welten, A.C. Fields, R.A. Malizia, J. Yoo, J.L. Irani, J.E. Goldberg, R. Bleday, N. Melnitchouk
• Journal: Journal of Gastrointestinal Surgery
• Published: 2022;26(1):161-170
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals.

Methods: This was a retrospective cohort study using the National Cancer Database to identify patients with malignant peritoneal mesothelioma from 2004 to 2016. Patients were divided according to treating facility type: academic or community. Outcomes were assessed using log-rank tests, Cox proportional-hazard modeling, and Kaplan-Meier survival statistics.

Results: In total, 2682 patients with malignant peritoneal mesothelioma were identified. A total of 1272 (47.4%) were treated at an academic facility and 1410 (52.6%) were treated at a community facility. Five hundred forty-six (42.9%) of patients at academic facilities underwent debulking or radical surgery compared to 286 (20.2%) at community facilities. Three hundred sixty-six (28.8%) of patients at academic facilities received chemotherapy on the same day as surgery compared to 147 (10.4%) of patients at community facilities. Unadjusted 5-year survival was 29.7% (95% CI 26.7-32.7) for academic centers compared to 18.3% (95% CI 16.0-20.7) for community centers. In multivariable analysis, community facility was an independent predictor of increased risk of death (HR: 1.19, 95% CI 1.08-1.32, p = 0.001).

Conclusions: We demonstrate better survival outcomes for malignant peritoneal mesothelioma treated at academic compared to community facilities. Patients at academic centers underwent surgery and received chemotherapy on the same day as surgery more frequently than those at community centers, suggesting that malignant peritoneal mesothelioma patients may be better served at experienced academic centers.

© 2021. The Society for Surgery of the Alimentary Tract.

In plain English

This retrospective cohort study compared survival among 2682 patients in the US National Cancer Database diagnosed with primary malignant peritoneal mesothelioma from 2004 to 2016. Of these, 1272 were treated at academic facilities and 1410 at community facilities. The database did not record asbestos exposure. Patients at academic facilities more often had debulking or radical surgery (42.9% versus 20.2%). They more often received chemotherapy on the same day as surgery (28.8% versus 10.4%). The authors treated same-day chemotherapy as a stand-in for heated intraperitoneal chemotherapy (HIPEC), calling this a significant assumption. Unadjusted median survival was 24.8 months (95% CI 22.2 to 27.9) at academic centers and 11.6 months (95% CI 10.2 to 13.0) at community centers. Unadjusted five-year survival was 29.7% (95% CI 26.7 to 32.7) at academic centers and 18.3% (95% CI 16.0 to 20.7) at community centers. After adjusting for patient, disease and treatment factors, treatment at a community facility was associated with a higher risk of death (hazard ratio 1.19, 95% CI 1.08 to 1.32). The authors concluded that patients may be better served at experienced academic centers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study using a national cancer registry database (National Cancer Database)
• Who was studied: 2682 patients diagnosed with primary malignant peritoneal mesothelioma (mesothelioma not otherwise specified, epithelioid or biphasic histology) between 2004 and 2016 at accredited US cancer centers; 1272 treated at academic facilities and 1410 at community facilities
• Exposure: Not an asbestos exposure study. The comparison was type of treating facility: academic/research versus community (community cancer program, comprehensive community cancer program, or integrated network cancer program). Asbestos exposure was not recorded in the database.
• Main results:
  • Debulking or radical surgery: 546 (42.9%) of patients at academic facilities versus 286 (20.2%) at community facilities
  • Chemotherapy on the same day as surgery: 366 (28.8%) of patients at academic facilities versus 147 (10.4%) at community facilities
  • Unadjusted median survival: 24.8 months (95% CI 22.2 to 27.9) at academic centers versus 11.6 months (95% CI 10.2 to 13.0) at community centers
  • Unadjusted 5-year survival: 29.7% (95% CI 26.7 to 32.7) at academic centers versus 18.3% (95% CI 16.0 to 20.7) at community centers
  • In the multivariable analysis, treatment at a community facility was associated with a higher risk of death compared with an academic facility (HR 1.19, 95% CI 1.08 to 1.32, p = 0.001)
  • Among all patients, same-day chemotherapy was associated with a lower risk of death than no chemotherapy (HR 0.55, 95% CI 0.46 to 0.65)
  • In adjusted survival curves, the academic advantage widened in subgroups, and was largest among patients treated with both chemotherapy and surgery
• The authors' conclusion: The authors concluded that survival was better at academic than community facilities. They suggested that patients with malignant peritoneal mesothelioma may be better served at experienced academic centers.
• Limitations the authors state:
  • The database does not distinguish intravenous from intraperitoneal chemotherapy. Treating same-day chemotherapy as HIPEC was an assumption the authors said they cannot rely on.
  • The database cannot quantify the extent of peritoneal disease or the completeness of surgery. A true case-volume analysis was therefore not possible.
  • The authors noted that not all academic facilities necessarily have more mesothelioma expertise or case volume than all community facilities.
  • Histology was recorded as mesothelioma not otherwise specified for most patients, although subtype affects prognosis.
  • The database does not record risk factors such as asbestos exposure.
  • Only overall survival was available. Disease-specific recurrence was not reported, so recurrence after surgery could not be compared.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Cohort Study, Chemotherapy.

Related studies

• Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital — B. Goslin, S. Sevak, et al. (2012)
• Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival — V. Verma, R.L. Sleightholm, et al. (2018)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis — D. Magge, M.S. Zenati, et al. (2014)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)

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