Real-world outcomes of multimodal treatment for pleural mesothelioma: A retrospective study in a high-volume integrated regional center

Objective: To evaluate overall survival (OS) associated with multimodal treatment regimens, including pleurectomy/decortication (PD) and systemic therapy, in patients with clinical stage I-II epithelioid pleural mesothelioma (PM). Methods: We identified patients with PM treated within an integrated health care system (2009-2023). We grouped patients by treatment: no treatment, surgery, systemic therapy, and multimodal treatment (surgery + systemic therapy). The primary outcome was median OS. Using multivariable Cox regression, we assessed associations between treatment and OS, adjusting for clinical characteristics. Subgroup analyses were performed for patients with clinical stage I-II epithelioid PM. Conclusions: In a real-word cohort of patients with early-stage epithelioid PM, multimodal treatment incorporating surgery and systemic therapy was associated with improved OS compared with no treatment. These findings reinforce the benefit of surgery in carefully selected patients, despite recent studies questioning its role in a broader population.