331 * Predictors of Long-term Survival Following Radical Surgery for Malignant Pleural Mesothelioma
Year: 2013
Type: conference-abstract
Abstract: Objectives: The aim of radical surgery for malignant pleural mesothelioma (MPM) is to achieve greater survival than from chemotherapy alone. Although adverse overall prognostic factors have already been determined, our aim was to identify the most important factors affecting long-term survival arbitrarily defined as greater than 24 months. Methods: We retrospectively reviewed the records of the 252 patients (35 female; 193 epithelioid and 59 biphasic; 112 extrapleural pneumonectomy [EPP], 140 extended pleurectomy decortication [RPD]) who survived for at least 90 postoperative days. We tested for factors affecting overall cancer-related mortality and specific clinical factors predicting 24-month survival. Results: Overall median survival was 18.2 (SE 1.2, 95% CI 15.8-20.7) months. There was no difference in survival between EPP and RPD (P = 0.91). One-hundred and twenty-eight patients received induction, adjuvant or palliative chemotherapy. Seventy-seven patients survived for >24 months. On univariate analysis, age older than 60 years (P = 0.044), pT4 stage (P = 0.041), any lymph node metastases (P = 0.002), biphasic cell type (P < 0.001) and no chemotherapy (P < 0.001) were associated with decreased survival. On multivariate analysis, age <60 years (P = 0.018, HR = 0.7), epithelioid disease (P = 0.001, HR = 0.56), negative nodes (P = 0.009, HR = 0.67) and any chemotherapy (P < 0.001, HR = 1.9) were associated with survival. Factors predicting survival over 24 months included age < 60 years (P = 0.014), epithelioid histology (P = 0.000), negative nodes (P = 0.001) and chemotherapy (P = 0.022). Conclusions: These results support a policy of accurate tissue diagnosis, nodal staging and induction chemotherapy prior to radical surgery for MPM. Trials investigating the additional role of surgery should be focused on confirming and refining these selection criteria.
Authors: A. Nakas, D. A. Waller
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2315387820