Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma
Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma
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DOI：
10.1093/ejcts/ezv398
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发表时间：
2016-05-01
影响因子：
3.4
通讯作者：
Opitz, Isabelle
中科院分区：
文献类型：
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作者：
Kostron, Arthur;Friess, Martina;Opitz, Isabelle
目的：分析恶性胸膜间皮瘤（MPM）患者复发后的复发模式及二线治疗的影响。方法：1999年9月至2013年12月，136例MPM诱导化疗后行胸膜外全肺切除术（MCR）。我们分析了106例到2014年10月出现复发性疾病的患者。从我们的间皮瘤数据库中检索数据，并通过检查影像学和医疗记录收集有关精确定位的额外信息。结果：总复发率为78%（106/136例）。术后9个月无复发的中位时间[95%可信区间（95% CI） 7-10]。仅局部复发33例（31%），远处转移27例（26%），远处和局部同时复发46例（43%）。接受辅助放疗的患者局部复发率显著降低（19% vs 47%, P = 0.003），但对总生存期（OS）无显著影响[放疗：22个月（95% CI 19-24）；无放疗：23个月（95% CI 18-27）， P = 0.6]。中位生存期为22个月（95% CI 21-24），中位复发后生存期（PRS）为7个月（95% CI 5-9），与仅远处复发（5个月，95% CI 2-8）或远处加局部复发（6个月，95% CI 3-9; P = 0.04）的患者相比，仅局部复发的患者存活时间明显更长（12个月，95% CI 8-16）。共有78例患者在肿瘤复发后接受了二线治疗：化疗（n = 48）、局部放疗（n = 9）、手术（n = 10）或联合化疗（n = 11）。与未接受治疗的患者相比，接受二线治疗的患者生存期明显延长（P < 0.0005）。术后中位PRS明显长于化疗、放疗或放化疗组（P = 0.04）。结论：即使在包括MCR在内的多模式治疗后，MPM的局部复发仍然是最常见的复发类型。在本队列中，积极治疗似乎对患者有益，因为局部肿瘤复发的手术切除在选定的患者中具有良好的长期预后。因此，二线治疗可能延长PRS；然而，这些结果需要以一种前瞻性的方式得到证实。
OBJECTIVES: To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment.METHODS: Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records.RESULTS: The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median postrecurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P < 0.0005). The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio-or chemo-radiotherapy (P = 0.04).CONCLUSIONS: Local recurrence of MPM remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS; however, these results need to be confirmed in a prospective manner.