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: BACKGROUND
  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(2) 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.
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA. Raja.flores@mountsinai.org
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.forename: Jessica Scott
authors.initials: JS
authors.lastname: Donington
authors.forename: William
authors.initials: W
authors.lastname: Alago
authors.forename: Ugonna
authors.initials: U
authors.lastname: Ihekweazu
authors.forename: Lee
authors.initials: L
authors.lastname: Krug
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rosenzweig
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
authors.forename: Michele
authors.initials: M
authors.lastname: Carbone
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D055812:Community-Based Participatory Research; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D018426:SEER Program; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult