title: Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma.
abstract: Although malignant pleural mesothelioma (MPM) is generally a disease associated with more advanced age, the association of age, treatment, and outcomes has not been well-characterized. We evaluated the impact of age on outcomes in patients with MPM to provide data for use in the treatment selection process for elderly patients with potentially resectable disease.
  
  
  
  Overall survival (OS) of patients younger than 70 and 70 years or older with Stage I to III MPM who underwent cancer-directed surgery or nonoperative management in the Surveillance, Epidemiology, and End Results database (2004-2010) was evaluated using multivariable Cox proportional hazard models and propensity score-matched analysis.
  
  
  
  Cancer-directed surgery was used in 284 of 879 (32%) patients who met inclusion criteria, and was associated with improved OS in multivariable analysis (hazard ratio, 0.71; P = .001). Cancer-directed surgery was used much less commonly in patients 70 years and older compared with patients younger than 70 years (22% [109/497] vs. 46% [175/382]; P < .001), but patients 70 years and older had improved 1-year (59.4% vs. 37.9%) and 3-year (15.4% vs. 8.0%) OS compared with nonoperative management. The benefit of surgery in patients 70 years and older was observed even after propensity score-matched analysis was used to control for selection bias.
  
  
  
  Surgical treatment is associated with improved survival compared with nonoperative management for both patients younger than 70 years and patients aged 70 years or older.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Chi-Fu Jeffrey
authors.initials: CJ
authors.lastname: Yang
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Yan
authors.affiliation: Department of Immunology, Duke University Medical Center, Durham, NC.
authors.forename: Robert Ryan
authors.initials: RR
authors.lastname: Meyerhoff
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Shakir M
authors.initials: SM
authors.lastname: Saud
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA. Electronic address: berry037@stanford.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016016:Proportional Hazards Models; D018426:SEER Program; D015996:Survival Rate; D013997:Time Factors
keywords: Elderly; Geriatric; Non-sarcomotoid; Operative; Survival