Propensity matched comparison of extrapleural pneumonectomy and pleurectomy/decortication for mesothelioma patients
Propensity matched comparison of extrapleural pneumonectomy and pleurectomy/decortication for mesothelioma patients
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DOI：
10.1093/icvts/ivw422
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发表时间：
2017-05-01
影响因子：
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通讯作者：
Opitz, Isabelle
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文献类型：
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作者：
Kostron, Arthur;Friess, Martina;Opitz, Isabelle
目的：采用倾向评分匹配分析的方法，对167例间皮瘤患者行胸膜外肺切除术(EPP)或全肺切除/去皮质(P/D)诱导化疗后的围手术期结局、总生存率和无复发的情况进行评估。根据性别、侧别、上皮样组织亚型和国际间皮瘤兴趣组(IMIG)分期(52个EPP和26个P/D)进行2：1倾向评分匹配。结果：两组术后主要并发症发生率(48%比58%，P=0.5)相似，但并发症发生率和严重程度不同，P/D组更倾向于P/D组；P/D组90d死亡率(8%比0%，P=0.3)较低，但差异无统计学意义。15例(58%)患者发生长时间漏气(>；=10天)，术后重症监护室住院时间明显延长(P=0.001)。两组无复发时间相似(EPP：中位15个月，95%可信区间：10-21；P/D：13个月，95%可信区间：11-17)(P=0.2)。P/D组的总生存期(中位数32个月，95%CI：29~35)明显长于P P组(23个月，95%CI：21~25)(P=0.031)，但P/D组的许多病例被审查(73%)，且随访时间相对较短。结论：P/D组和E组的主要并发症发生率相似，但并发症的发生率不同且更为严重。两组患者的无复发能力具有可比性，而总体存活率的改善需要在长期随访的大患者组中得到证实。
OBJECTIVES: The objective of this retrospective study was to assess perioperative outcomes, overall survival and freedom from recurrence after induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) in patients with mesothelioma in a propensity score matched analysis.METHODS: Between September 1999 and August 2015, 167 patients received multimodality treatment (platinum-based chemotherapy followed by EPP [n=141] or P/D [n=26]). We performed 2:1 propensity score matching for gender, laterality, epithelioid histological subtype and International Mesothelioma Interest Group (iMig) stage (52 EPP and 26 P/D).RESULTS: Postoperative major morbidity (48% vs 58%, P=0.5) was similar in both groups; however, the complication profile and severity were different and favoured P/D; the 90-day mortality (8% vs 0%, P=0.3) rate was lower in P/D although not statistically significant. Prolonged air leak (>= 10 days) occurred in 15 patients (58%) undergoing P/D. The intensive care unit stay was significantly longer after EPP (P=0.001). Freedom from recurrence was similar for both groups (EPP: median 15 months, 95% confidence interval [CI]: 10-21; P/D: 13 months, 95% CI: 11-17) (P=0.2). Overall survival was significantly longer for patients undergoing P/D (median 32 months, 95% CI: 29-35) compared to EPP (23 months, 95% CI: 21-25) (P=0.031), but in the P/D group many cases were censored (73%) and the follow-up time was relatively short.CONCLUSIONS: P/D and EPP seem to have similar rates of major morbidity, although the profile of complications is different and more severe after EPP. Freedom from recurrence is comparable in both groups whereas improved overall survival needs to be confirmed in a large patient group with longer follow-up.