Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically
Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically
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DOI：
10.1016/s0003-4975(99)01038-3
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发表时间：
1999-11-01
影响因子：
4.6
通讯作者：
Venkatraman, ES
中科院分区：
文献类型：
--
作者：
Rusch, VW;Venkatraman, ES
背景影响恶性胸膜间皮瘤（MPM）切除术后结果的因素存在争议。本前瞻性手术数据库的分析确定了重要的预后因素。根据国际间皮瘤兴趣组分期系统对肿瘤进行分期，并对患者进行随访直至死亡。预后因素采用对数秩和考克斯回归分析，P <0.05为显著性。从1983年10月至1998年5月，231例患者接受开胸手术，115例行胸膜外全肺切除术（EPP），59例行胸膜剥脱术（P/D）。在患有EPP或P/D的患者中，142例接受了辅助治疗。I期肿瘤的中位生存期为29.9个月，II期为19个月，III期为10.4个月，IV期为8个月。多因素分析显示，分期、组织学类型、性别、辅助治疗是影响预后的重要因素，而手术切除类型无统计学意义。在长期随访的大型数据库中，没有发现P/D比EPP更好的生存率。I期和II期的生存率比MPM通常假设的要高。局部晚期T和N状态，以及非上皮组织学，确定预后不良的患者，应考虑新的治疗方案。(C)1999年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. The factors influencing outcome after resection of malignant pleural mesothelioma (MPM) are controversial. This analysis of a prospective surgical database identifies important prognostic factors.Methods. Tumors were staged by the International Mesothelioma Interest Group staging system, and patients were followed until death. Prognostic factors were analyzed by log rank and Cox regression, and were considered significant if p was less than 0.05.Results. From Oct 1983 to May 1998, 231 patients underwent thoracotomy, 115 had extrapleural pneumonectomy (EPP), and 59 pleurectomy/decortication (P/D). Among patients having EPP or P/D, 142 received adjuvant therapy. The median survival for stage I tumors was 29.9 months, for stage II 19 months, for stage III 10.4 months, and for stage IV 8 months. By multivariate analysis, stage, histology, gender, adjuvant therapy, but not the type of surgical resection, were significant.Conclusions. The better survival previously reported for P/D compared with EPP is not seen in a large database with long follow-up. Stages I and II have better survival rates than generally assumed for MPM. Locally advanced T and N status, and nonepithelial histology, identify poor prognosis patients who should be considered for novel treatment regimens. (C) 1999 by The Society of Thoracic Surgeons.