Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center
Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center
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DOI：
10.1097/jto.0b013e31815608d9
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发表时间：
2007-10-01
影响因子：
20.4
通讯作者：
Rusch, Valerie
中科院分区：
文献类型：
--
作者：
Flores, Raja M.;Zakowski, Maureen;Rusch, Valerie
简介：大多数描述恶性胸膜间皮瘤的自然史和预后因素的研究早于准确的病理诊断、计算机断层扫描分期和通用分期系统。我们进行了一项大型单机构分析，以确定预后因素并评估切除与当代患者群体结果的关联。方法：确定了我们机构中经活检证实的恶性胸膜间皮瘤患者，并从机构数据库中获得了临床数据。通过Kaplan-Meier法、对数秩检验和Cox比例风险分析来分析生存和预后因素。 p 值 < 0.05 被认为具有统计学意义。 结果：从 1990 年到 2005 年，共鉴定了 945 名患者：755 名男性，190 名女性；中位年龄 66 岁（范围 26-93）。 208 例 (22%) 进行了胸膜外全肺切除术，176 例 (19%) 进行了胸膜切除/皮质剥除术。手术死亡率为 4% (16/384)。包括手术在内的多学科治疗与 20.1 个月的中位生存期相关。总生存率的重要预测因素包括组织学、性别、吸烟、石棉暴露、偏侧性、胸膜外全肺切除术或胸膜切除术/剥脱术的手术切除、美国癌症联合委员会分期和症状。在控制组织学、分期、性别、石棉暴露、吸烟史、症状和偏侧性时，Cox 模型显示无需手术切除的风险比为 1.4 (p < 0.003)。结论：除了肿瘤组织学和病理分期外，生存预测因素还包括性别、石棉暴露、吸烟、症状、偏侧性和临床分期。多模式环境下的手术切除与生存率的提高相关。
Introduction: Most studies describing the natural history and prognostic factors for malignant pleural mesothelioma antedate accurate pathologic diagnosis, staging by computed tomography, and a universal staging system. We conducted a large single-institution analysis to identify prognostic factors and assess the association of resection with outcome in a contemporary patient population.Methods: Patients with biopsy-proven malignant pleural mesothelioma at our institution were identified and clinical data were obtained from an institutional database. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. A p value < 0.05 was considered statistically significant.Results: From 1990 to 2005, 945 patients were identified: 755 men, 190 women; median age, 66 years (range, 26-93). Extrapleural pneumonectomy was performed in 208 (22%), pleurectomy/decortication in 176 (19%). Operative mortality was 4% (16/384). Multimodality therapy- including surgery was associated with a median survival of 20.1 months. Significant predictors of overall survival included histology, gender, smoking, asbestos exposure, laterality, surgical resection by extrapleural pneumonectomy or pleurectomy/ decortication, American Joint Committee on Cancer stage, and symptoms. A Cox model demonstrated a hazard ratio of 1.4 without surgical resection when controlling for histology, stage, gender, asbestos exposure, smoking history, symptoms, and laterality (p 0.003).Conclusions: In addition to tumor histology and pathologic stage, predictors of survival include gender, asbestos exposure, smoking, symptoms, laterality, and clinical stage. Surgical resection in a multimodality setting was associated with improved survival.