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Original Articles: General Thoracic

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

^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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