Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients.
Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients.
复制标题
胸膜外肺切除术治疗上皮性恶性胸膜间皮瘤：基于529名患者的经验，N1和N2结节介入的新型预后意义。
DOI：
10.1097/sla.0000000000000903
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发表时间：
2014-10
影响因子：
9
通讯作者：
Bueno R
中科院分区：
文献类型：
--
作者：
Sugarbaker DJ;Richards WG;Bueno R
我们回顾我们24年的经验，胸膜外全肺切除术（EPP）治疗上皮样恶性胸膜间皮瘤（MPM）。最近的出版物，特别是Treasure等人的MARS（间皮瘤和根治性手术）可行性研究，质疑EPP治疗MPM的安全性和有效性。对机构审查委员会批准的前瞻性单中心数据库进行了回顾性审查。报告了总生存期的描述性统计量和Kaplan-Meier分析。从1988年到2011年，共有529例上皮样MPM患者接受了EPP完全切除术，作为多模式策略的一部分。其中，131人（25%）为女性，中位年龄为59岁（范围：17-79岁）。中位术后住院时间为10（范围，1-101）天。26例患者（5%）发生30天或住院死亡。中位总生存期为18个月，1年、3年、5年和10年生存率分别为67%、28%、14%和4%。按病理淋巴结状态（N，中位总生存期）分类的结局为N 0：224，26个月; N1：118，17个月; N2：181，13个月; N3：5，7个月; Nx：1，不可评估。EPP已发展成为一种有效的方法，宏观完全切除。这项研究证实，淋巴结状态与上皮样MPM患者接受EPP的总生存率显着相关，并表明那些同时参与N1和N2站的风险增加。这一观察结果强调了对N1和N2站进行彻底分期的必要性，并对MPM分期标准的修订产生了影响。
We review our 24-year experience with extrapleural pneumonectomy (EPP) in the treatment of epithelioid malignant pleural mesothelioma (MPM). Recent publications, particularly the MARS (Mesothelioma and Radical Surgery) feasibility study by Treasure et al, have questioned the safety and efficacy of EPP for MPM. An institutional review board–approved, prospective, single-center database was retrospectively reviewed. Descriptive statistics and Kaplan-Meier analysis of overall survival are reported. From 1988 to 2011, a total of 529 patients with epithelioid MPM underwent complete resection by EPP as part of a multimodality strategy. Among these, 131 (25%) were women, and the median age was 59 (range, 17–79) years. Median postoperative hospital stay was 10 (range, 1–101) days. Twenty-six patients (5%) experienced 30-day or in-hospital mortality. Median overall survival was 18 months, with 1-, 3-, 5-, and 10-year survival rates of 67%, 28%, 14%, and 4%, respectively. Outcome by pathologic lymph node status (N, median overall survival) was N0: 224, 26 months; N1: 118, 17 months; N2: 181, 13 months; N3: 5, 7 months; Nx: 1, not evaluable. EPP has evolved as an effective method for macroscopic complete resection. This study confirms that lymph node status is significantly correlated with overall survival in patients with epithelioid MPM undergoing EPP and suggests that those with simultaneous involvement of N1 and N2 stations are at increased risk. This observation underscores the need for thorough staging of both N1 and N2 stations and has implications for revision of MPM staging criteria.