Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients
Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients
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DOI：
10.1016/j.jtcvs.2007.10.054
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发表时间：
2008-03-01
影响因子：
6
通讯作者：
Rusch, Valerie W.
中科院分区：
文献类型：
--
作者：
Flores, Raja M.;Pass, Harvey I.;Rusch, Valerie W.
目的：恶性胸膜间皮瘤切除术的最佳方法是有争议的，部分原因是以前的分析包括少数患者。我们进行了一项多机构的研究，以增加统计能力，以检测胸膜外全肺切除术和胸膜切除术/decortication.Methods之间的结果显着差异：恶性胸膜间皮瘤患者进行胸膜外全肺切除术或胸膜切除术/decortication在3个机构进行了鉴定。生存和预后因素进行了分析Kaplan-Meier法，对数秩检验，和考克斯比例风险analysis.Results：从1990年至2006年，663例连续患者（538名男性和125名女性）进行了切除。中位年龄为63岁（范围：26-93岁）。胸膜外全肺切除术的手术死亡率为7%（n = 27/385），胸膜切除术/皮质剥脱术的手术死亡率为4%（n = 13/278）。在美国癌症联合委员会1 - 4期（P <0.001）、上皮样与非上皮样组织学（P <0.001）、胸膜外全肺切除术与胸膜切除术/剥脱术（P <0.001）、综合治疗与单纯手术（P <0.001）和性别（P <0.001）中观察到显著的生存差异。多变量分析表明，胸膜外全肺切除术的风险率为1.4（P <0.001）控制阶段，组织学，性别，和multimodalitytherapy.Conclusion：患者进行胸膜切除术/去皮质比那些谁进行胸膜外全肺切除术有更好的生存，然而，原因是多因素的，并受到选择偏倚。目前，切除术的选择应根据疾病的程度、患者的合并症和计划的综合治疗类型进行调整。
Objective: The optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural pneumonectomy and pleurectomy/decortication.Methods: Patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis.Results: From 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26-93 years). The operative mortality was 7% for extrapleural pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy.Conclusion: Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.