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Ann Thorac Surg 2009;87:1552-1556. doi:10.1016/j.athoracsur.2009.01.026
© 2009 The Society of Thoracic Surgeons
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Original Articles: General Thoracic

Prognostic Features of Long-term Survivors After Surgical Management of Malignant Pleural Mesothelioma

Tristan D. Yan, MBBS, PhDa,b,e, Michael Boyer, MBBS, PhDc,d,e, Mo Mo Tin, MBBSc,d,e, Junyang Sim, BSc(Med), MBBSa,e, Catherine Kennedy, RM, RAa,b,e, Jocelyn McLean, RN, MNa,b,e, Paul G. Bannon, MBBS, PhDa,b,e, Brian C. McCaughan, MBBS, FRACSa,b,e,*

a Department of Cardiothoracic Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
b The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
c Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
e Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia
d Sydney Cancer Center, Sydney, Australia

Accepted for publication January 13, 2009.

* Address correspondence to *Prof McCaughan, Royal Prince Alfred Hospital, Department of Cardiothoracic Surgery, Newton, Sydney, 2000, Australia (Email: bmccaughan{at}scts.com.au).

Background: The primary aim of this study was to evaluate prognostic features of long-term survivors with pleural mesothelioma.

Methods: Overall survival outcome was analyzed in 456 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP), pleurectomy/decortications, or pleurodesis/biopsy with at least 18 months of follow-up. Prospectively collected clinicopathologic and treatment data were assessed for their correlations with actual 18-month survivors in both univariate and multivariate analyses.

Results: The actual 18-month survival was 28%. Epithelial subtype was present in 185 patients (41%) and nonepithelial subtype in 183 (40%). Procedures were EPP in 59 patients (13%), pleurectomy/decortication in 250 (55%), and pleurodesis/biopsy in 147 (32%). Forty-two patients (9%) underwent positron emission tomography (PET) scanning. Forty patients (9%) received adjuvant radiotherapy and 45 (10%) received postoperative pemetrexed combination chemotherapy. In univariate analysis, age 65 years or younger (p < 0.001), malignant pleural effusion (p = 0.041), epithelial subtype (p < 0.001), EPP (p < 0.001), PET scan (p = 0.012), adjuvant radiotherapy (p = 0.042), and postoperative pemetrexed combination chemotherapy (p = 0.035) were strongly associated with 18-month survivors. In multivariate analysis, epithelial histopathologic subtype (p < 0.001) and EPP (p < 0.001) were independently associated with 18-month survivors.

Conclusions: The actual 18-month survival was 28% in 456 pleural mesothelioma patients who underwent operation. Epithelial histologic subtype and EPP were identified as independent predictors for 18-month survivors.


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