Malignant pleural mesothelioma:: Clinicopathologic and survival characteristics in a consecutive series of 394 patients
Malignant pleural mesothelioma:: Clinicopathologic and survival characteristics in a consecutive series of 394 patients
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DOI：
10.1016/j.ejcts.2007.09.044
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发表时间：
2008-02-01
影响因子：
3.4
通讯作者：
Ardissone, Francesco
中科院分区：
文献类型：
--
作者：
Borasio, Piero;Berruti, Alfredo;Ardissone, Francesco
目的：恶性胸膜间皮瘤（MPM）的治疗仍然令人失望，虽然最近的报告表明，包括手术在内的多模式治疗可能会提供一个显着的生存优势。这项单中心研究的目的是：研究MPM患者的临床病理特征和潜在的预后因素，并确定手术后辅助治疗是否具有独立的预后作用。方法：回顾性分析1989年至2003年间所有MPM患者的前瞻性计算机数据库。统计学分析采用Kaplan-Meier法、log-rank检验和考克斯模型。结果：共有394名患者：270名男性（68.5%），124名女性，中位年龄64岁（范围28-93）。27例患者（6.8%）接受了手术切除（胸膜外全肺切除术15例，胸膜切除术/去皮质术12例），随后接受了辅助治疗。截至2006年3月，381例患者（96.7%）死亡（中位生存期，11.7个月;范围0.03-117.9）。13例存活患者（3.3%）的中位随访时间为45.2个月（范围28.7-126.5）。2年总生存率为18.8%。包括手术在内的综合治疗的中位生存期为14.5个月，2年生存率为29.6%。使用单变量分析，年龄（p = 0.009），胸痛（p = 0.01），体重波动（p = 0.001），体能状态（p = 0.0001），血小板计数（p = 0.008），组织学（p = 0.0001），胸膜表面的肉眼外观（非特异性炎症、肿瘤样增厚或结节; p = 0.0001），脏层胸膜受累（p = 0.0001）、胸膜腔受累程度（小于或大于三分之一腔; p = 0.0001）和综合治疗（p < 0.01）被认为是重要的预后因素。在多变量分析中，体力状态、血小板计数、组织学和胸膜腔受累程度与生存率独立相关，而多模式治疗未能进入模型。结论：生存的重要预测因素包括体力状态、血小板计数、组织学和胸膜腔受累程度。在这项回顾性研究的范围内，接受多种治疗的患者数量较少，手术在MPM治疗中的作用仍不清楚。需要进一步研究以确定这种疾病的最佳治疗策略。(C)2007年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: Treatment of malignant pleural mesothelioma (MPM) remains disappointing, although recent reports suggest that multimodality therapy including surgery may provide a significant survival benefit. The aims of this single institution study were: to investigate clinicopathologic characteristics and potential prognostic factors in MPM patients, and to ascertain whether surgery followed by adjuvant therapy had an independent prognostic role. Methods: Retrospective review of a prospectively compiled computerized database of all patients with MPM evaluated between 1989 and 2003. Kaplan-Meier method, log-rank test, and Cox model were used in the statistical analysis. Results: There were 394 patients: 270 men (68.5%), 124 women, median age 64 (range 28-93). Twenty-seven patients (6.8%) underwent surgical resection (extrapleural pneumonectomy 15, pleurectomy/decortication 12), followed by adjuvant therapy. As of March 2006, 381 patients (96.7%) had died (median survival, 11.7 months; range 0.03-117.9). Median follow-up of 13 surviving patients (3.3%) was 45.2 months (range 28.7-126.5). Overall survival at 2 years was 18.8%. Multimodality therapy including surgery yielded a median survival of 14.5 months and a 2-year survival rate of 29.6%. Using univariate analysis, age (p = 0.009), chest pain (p = 0.01), weight toss (p = 0.001), performance status (p = 0.0001), platelet count (p = 0.008), histology (p = 0.0001), macroscopic appearance of pleural surface (non-specific inflammation, tumor-like thickening, or nodules; p = 0.0001), visceral pleura involvement (p = 0.0001), degree of involvement of pleural cavity (less than or more than one third of the cavity; p = 0.0001), and multimodality therapy (p < 0.01) were found to be significant prognostic factors. At multivariate analysis, performance status, platelet count, histology, and degree of involvement of pleural cavity remained independently associated with survival, whereas multimodality therapy failed to enter the model. Conclusions: Significant predictors of survival include performance status, platelet count, histology, and degree of involvement of pleural cavity. Within the confines of this retrospective study and the small number of patients undergoing multimodality therapy, the role of surgery in the treatment of MPM remains unclear. Further investigation is warranted to determine the optimal treatment strategy in this disease. (C) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.