Racial Disparities in Treatment Patterns and Survival Among Surgically Treated Malignant Pleural Mesothelioma Patients

Surgery may improve survival in malignant pleural mesothelioma (MPM) patients. We examined treatment and survival in black and white surgical MPM patients using the National Cancer Database (NCDB). Among patients with pleurectomy/decortication (PD) or extrapleural pneumonectomy (EPP), multivariable logistic regressions were used to evaluate racial differences in surgical extent, additional treatment, and 30-/90-day mortality. Multivariable and propensity matched models were used to assess differences in survival. We identified 2550 patients; 2462 white (96.5%), 88 black (3.5%). Black patients were significantly less likely to receive EPP (OR_adj 0.36, 95% CI 0.17–0.78) and trended towards worse 30-/90-day mortality (OR_adj 1.54, 95% CI 0.59–4.03; OR_adj 1.59, 95% CI 0.80–3.17, respectively). There was no difference in survival (HR_adj 0.94, 95% CI 0.71–1.25). Surgery conferred a survival benefit (HR_adj 0.77, 95% CI 0.73–0.82), but it varied by race (HR_adj[white] 0.76, 95% CI 0.72–0.81; HR_adj[black] 0.93, 95% CI 0.67–1.29). With the limitation of a small proportion of surgically resected black MPM patients in this population-based analysis, black patients were noted to undergo less extensive surgery. Although there was an overall survival benefit noted with surgery, this was not consistent across races, despite trends towards worse short-term mortality in black patients.