Abstract
<title>Abstract</title> <p> Background The role of surgical resection in the management of malignant pleural mesothelioma (MPM) remains unclear. Methods MPM patients were identified from the SEER database and classified into surgical and non-surgical groups. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (sIPTW) were used to adjust for confounders. Survival was assessed using Kaplan-Meier and Cox proportional hazards models. Patients were further divided into two cohorts based on study periods (2000–2009 <italic>vs</italic> 2010–2018) to analyze survival trends over the last two decades. Results A total of 6,008 patients were analyzed, with 2,026 undergoing surgery. Surgical patients had significantly better overall survival than non-surgical patients (17 months [95% CI: 16–18] vs. 9 months [95% CI: 8–9]; HR: 0.6 [95% CI: 0.57–0.64]; P < 0.0001). Among those eligible for surgery, surgery was associated with longer survival (17 months [95% CI: 16–18] vs. 10 months [95% CI: 8–12]; HR: 0.66 [95% CI: 0.57–0.76]; P < 0.0001). Female patients showed improved survival within the surgical group. Over the past two decades, survival in surgical patients has improved, with increasing surgical acceptance, though the increase was smaller in women. Conclusions Surgical resection provides a survival benefit in MPM, particularly for women. The efficacy of surgery has improved over the past two decades, but more efforts are needed to reduce surgical candidate attrition. </p>