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

Our plain-English summary of Real-world outcomes of multimodal treatment for pleural mesothelioma: A retrospective study in a high-volume integrated regional center, by A.S. Baskin, K. Levine, Y.Y. Hung, et al (JTCVS Open, 2026).

The study

• Authors: A.S. Baskin, K. Levine, Y.Y. Hung, E. Liang, K.C. Banks, J.M. Suga, J.B. Velotta
• Journal: JTCVS Open
• Published: 2026;30:101603
• Read it: PubMed · Publisher · Free full text

Abstract

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.

Results: Among all eligible patients (n = 432), those who received no treatment (n = 198), surgery (n = 25), systemic therapy (n = 164), and multimodal treatment (n = 45) had median OS of 5 months (95% CI, 4-7), 11 (6-17), 13 (12-17), and 27 (20 to nonestimable [NE]) (P < .0001). Among patients with clinical stage I-II epithelioid PM (n = 112), those who received no treatment (n = 40), surgery (n = 10), systemic therapy (n = 42), and multimodal treatment (n = 20) had median OS of 10 (7-17), 29 (5-NE), 18 (17-26), and 37 (25-NE) months (P < .0005). Adjusted analyses showed improved OS relative to no treatment with multimodal treatment but not systemic therapy in the clinical stage I-II epithelioid subgroup (multimodal therapy: adjusted hazard ratio, 0.35; 95% CI, 0.15-0.85, P = .02; systemic therapy: adjusted hazard ratio, 0.66; 95% CI, 0.37-1.16, P = .15).

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.

© 2026 The Author(s).

In plain English

This retrospective study examined 432 adults with pleural mesothelioma treated at Kaiser Permanente Northern California from 2009 to 2023. Patients were grouped by treatment received: none (198), pleurectomy/decortication surgery without systemic therapy (25), systemic therapy without surgery (164), or surgery followed by chemotherapy ("multimodal", 45); treated patients may also have had radiation. Median overall survival was 5.4 months (95% CI 4.3-7.2), 10.6 (6.3-17.4), 13.3 (11.5-17.1) and 26.8 (19.7 to not estimable). In 112 patients with stage I-II epithelioid disease, the figures were 10.3 (7.4-16.5), 29.0 (5.3 to not estimable), 18.2 (17.4-26.1) and 37.3 (25.0 to not estimable) months. After adjusting for age, sex, diagnosis period and comorbidity, multimodal treatment in this subgroup was associated with lower risk of death than no treatment (adjusted hazard ratio 0.35; 95% CI 0.15-0.85). Systemic therapy without surgery was not statistically significant here (0.66; 0.37-1.16). Among 70 surgical patients, 7.1% died within 30 days and 12.9% within 90. The authors concluded surgery has a continued role in carefully selected patients. They noted likely residual confounding and that comparisons were not meant to establish causation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Multicenter retrospective observational study (review of medical records and a cancer registry) comparing survival by treatment received
• Who was studied: Adults aged 18 or older with histologically confirmed pleural mesothelioma treated within Kaiser Permanente Northern California from January 1, 2009 to December 31, 2023. Of 438 patients identified, 6 who had extrapleural pneumonectomy were excluded, leaving 432. A subgroup of 112 had clinical stage I-II epithelioid disease.
• Exposure: Not an asbestos exposure study. The 'exposure' compared was treatment received: no treatment, pleurectomy/decortication surgery without systemic therapy, systemic therapy without surgery, or multimodal treatment (surgery followed by chemotherapy). Patients in the treated groups may also have received radiation. Asbestos exposure is not reported.
• Main results:
  • Entire cohort (n = 432), unadjusted median overall survival: 5.4 months (95% CI 4.3-7.2) with no treatment, 10.6 months (6.3-17.4) with surgery without systemic therapy, 13.3 months (11.5-17.1) with systemic therapy without surgery, and 26.8 months (19.7 to nonestimable) with multimodal therapy (P < .0001)
  • Early-stage epithelioid subgroup (n = 112), unadjusted median overall survival: 10.3 months (7.4-16.5) with no treatment (n = 40), 29.0 months (5.3 to nonestimable) with surgery without systemic therapy (n = 10), 18.2 months (17.4-26.1) with systemic therapy without surgery (n = 42), and 37.3 months (25.0 to nonestimable) with multimodal therapy (n = 20)
  • Entire cohort, adjusted analysis versus no treatment: systemic therapy aHR 0.56 (95% CI 0.44-0.70, P < .001) and multimodal therapy aHR 0.32 (95% CI 0.21-0.51, P < .001) were significantly associated with improved overall survival
  • Early-stage epithelioid subgroup, adjusted analysis versus no treatment: multimodal therapy aHR 0.35 (95% CI 0.15-0.85, P = .02) remained significant. Systemic therapy aHR 0.66 (95% CI 0.37-1.16, P = .15) did not.
  • Surgery without systemic therapy, adjusted versus no treatment, was not statistically significant: aHR 0.78 (0.48-1.27, P = .32) in the entire cohort and 0.63 (0.24-1.67, P = .35) in the early-stage epithelioid subgroup
  • 24-month survival was highest with multimodal therapy: 54.9% (41.7-72.2%) in the entire cohort and 68.4% (50.4-92.9%) in the early-stage epithelioid subgroup
  • Among the 70 surgical patients in the entire cohort, 30-day complications occurred in 54.3%, 30-day major complications in 10.0%, 30-day mortality was 7.1% (5 of 70) and 90-day mortality 12.9% (9 of 70). In early-stage epithelioid surgical patients, the rates were 43.3%, 10.0%, 6.7% and 10.0%.
• The authors' conclusion: The authors concluded that multimodal therapy incorporating surgery and systemic treatment was associated with significantly improved overall survival, specifically in the early-stage epithelioid subgroup. In their view this supports a continued role for surgery in the right patients with the right approach. They added that high-level prospective research is still needed.
• Limitations the authors state:
  • Retrospective design is subject to selection bias. Groups reflect treatments actually received, not the treatments initially intended.
  • Residual confounding is likely because factors such as frailty that influence treatment choice were unavailable. The comparisons are descriptive and not intended to establish causation.
  • Specific systemic treatment regimens, including immunotherapy, were not distinguished
  • Findings come from one health system and may not generalize to other hospitals

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Overall Survival, Pleurectomy/Decortication (P/D), Systemic Therapy, Epithelioid, Multimodal Therapy, Hazard Ratio.

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