Radical surgery for malignant pleural mesothelioma: results and prognosis.
Radical surgery for malignant pleural mesothelioma: results and prognosis.
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DOI：
10.1510/icvts.2007.166322
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发表时间：
2008-02-01
影响因子：
--
通讯作者：
Tsubota, Noriaki
中科院分区：
文献类型：
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作者：
Okada, Morihito;Mimura, Takeshi;Tsubota, Noriaki
外科治疗恶性胸膜间皮瘤(MPM)的作用仍然存在争议。我们对接受MPM根治性手术的患者的预后进行了回顾。在87例手术探查活检证实的MPM患者中，31例患者接受了胸膜外肺切除术(EPP)，34例患者接受了全肺切除/去皮质手术(P/D)。65名患有EPP或P/D的患者包括58名男性(89%)。中位年龄60岁(35-78岁)，组织学类型为上皮型48例(74%)。I期8例(12%)，II期13例(20%)，III期40例(62%)，IV期4例(6%)。手术死亡率EPP组为3.2%，P/D组为0。EPP组中位生存期为13个月，3年生存率为33%，P/D组为17个月，3年生存率为24%。多因素分析显示，高龄(P=0.0467)、非上皮性组织学(P=0.0057)和P期Ⅲ-IV期疾病(P=0.0019)是影响预后的显著因素，而性别、侧别、手术方式无明显影响。虽然P/D在早期阶段似乎是可以接受的，但我们鼓励EPP，为了治愈而不进入胸腔进行整体切除，这提供了肿瘤学上对所有疾病的完全切除。
The role of surgical treatment for malignant pleural mesothelioma (MPM) continues to be controversial. We carried out a retrospective review of the prognosis in patients who had radical surgery for MPM. Of 87 consecutive patients on whom surgical exploration for biopsy-proven MPM was performed, 31 patients underwent extrapleural pneumonectomy (EPP) and 34 patients underwent pleurectomy/decortication (P/D). Sixty-five patients having EPP or P/D included 58 men (89%). The median age was 60 years (range 35-78) and the histologic type was epithelial in 48 patients (74%). IMIG staging classification was p-stage I disease in eight patients (12%), p-stage II in 13 (20%), p-stage III in 40 (62%) and p-stage IV in 4 (6%). Operative mortality was 3.2% for EPP and none for P/D. The median and 3-year survivals after EPP were 13 months and 33% whereas those after P/D were 17 months and 24%, respectively. A multivariate analysis demonstrated that older age (P=0.0467), non-epithelial histology (P=0.0057) and p-stage III-IV disease (P=0.0019), but not gender, side, surgical procedure, were significant independent negative prognostic factors. Although P/D appears to be acceptable in early stages, we encourage EPP, en bloc resection without entering the pleural cavity with intent for curability, which provides oncologically complete resection of all disease.