Age alone should not be an exclusion criterion for extended pleurectomy decortication among elderly patients with malignant pleural mesothelioma, according to a review of prospectively collected data presented at the European Lung Cancer Conference.
However, a thorough presurgical assessment of nodal disease and fitness is necessary before older patients undergo adjuvant chemotherapy, according to the researchers. These factors appeared to have a greater negative impact in older patients than younger patients.
Extended pleurectomy decortication (EPD) has been preferred over extrapleural pneumonectomy for patients with malignant pleural mesothelioma who meet strict criteria, according to the researchers.
Although EPD has shown feasibility for elderly patients, debate continues regarding the efficacy of this procedure for older patients.
Annabel J. Sharkey,
, a thoracic surgeon at Glenfield Hospital in Leicester, United Kingdom, and colleagues sought to review data regarding EPD safety and efficacy for elderly patients.
The analysis included 282 patients who underwent EPD with the intent of achieving macroscopic complete resection from 1999 to 2015. Researchers compared pathological, clinical, outcome and survival data from patients aged 70 years or older (28%) compared with patients aged younger than 70 years.
A greater proportion of patients in the elderly cohort than the younger cohort required intensive postoperative care (16.8% vs. 5.4%; P = .004) and developed atrial fibrillation (24.7% vs. 14.4%; P = .051).
Results showed no difference in median hospital length of stay (younger cohort, 12 days; older cohort, 14 days), in-hospital mortality (3.5% vs. 6.5%) or 90-day mortality (7.9% vs. 10.1%) between the groups.
However, elderly patients were less likely to receive adjuvant chemotherapy compared with their younger counterparts (29.6% vs. 47.5%; P = .04).
Despite this difference, median OS was comparable between the cohorts (younger cohort, 13 months; older cohort, 10.5 months).
However, among patients with nonepithelioid tumors, median survival for node-positive elderly patients was 3.8 months compared with 6.6 months for their younger node-positive counterparts (P = .024).
Although age was not a significant prognostic factor upon multivariate analysis, lack of adjuvant therapy (HR = 2.08, 95% CI, 1.37-3.17) and preoperative anemia (HR = 1.97, 95% CI, 1.29-3.01) were statistically associated with worse prognosis.
These data support more thorough preoperative evaluation, according to the researchers.
"Whilst age in isolation should not be an exclusion criteria for EPD for mesothelioma, in the elderly, a more rigorous preoperative evaluation of nodal disease and an additional assessment of fitness for adjuvant chemotherapy, or the consideration of neoadjuvant therapy are recommended," Sharkey and colleagues wrote. – by Nick Andrews
Sharkey AJ, et al. Abstract 207O. Presented at: European Lung Cancer Conference; April 13-16, 2016; Geneva.
: The researchers report no relevant financial disclosures.