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.

中文翻译：

---

学术医院与社区医院恶性腹膜间皮瘤的生存结果

 背景

恶性腹膜间皮瘤是一种罕见疾病，预后不佳。细胞减灭术联合腹腔热灌注化疗是治疗的基石。我们的目的是比较学术医院与社区医院治疗恶性腹膜间皮瘤的结果。

 方法

这是一项回顾性队列研究，使用国家癌症数据库来识别 2004 年至 2016 年的恶性腹膜间皮瘤患者。患者根据治疗机构类型进行分类：学术机构或社区。使用对数秩检验、Cox 比例风险模型和 Kaplan-Meier 生存统计来评估结果。

 结果

总共鉴定出 2682 名恶性腹膜间皮瘤患者。共有 1272 人（47.4%）在学术机构接受治疗，1410 人（52.6%）在社区机构接受治疗。学术机构的 546 名患者 (42.9%) 接受了减瘤或根治性手术，而社区机构的这一数字为 286 名 (20.2%)。学术机构的 366 名患者 (28.8%) 在手术当天接受了化疗，而社区机构的这一比例为 147 名 (10.4%)。学术中心未经调整的 5 年生存率为 29.7% (95% CI 26.7–32.7)，而社区中心为 18.3% (95% CI 16.0–20.7)。在多变量分析中，社区设施是死亡风险增加的独立预测因素（HR：1.19，95% CI 1.08-1.32， p = 0.001）。

 结论

我们证明，与社区设施相比，在学术机构治疗的恶性腹膜间皮瘤的生存结果更好。学术中心的患者接受手术并在手术当天接受化疗的频率高于社区中心的患者，这表明恶性腹膜间皮瘤患者在经验丰富的学术中心可能会得到更好的服务。