| | |  | | | | Record from Web of Science® | | | | | | |
| Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients |
|
|
| Author(s): Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Carson JM, DeCamp MM, Swanson SJ, Bueno R, Lukanich JM, Baldini EH, Mentzer SJ |
| Source: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Volume: 117 Issue: 1 Pages: 54-63 Published: JAN 1999 |
| Times Cited: 317 References: 43 |
| Abstract: Objectives: Our aim was to identify prognostic variables for long-term postoperative survival in trimodality management of malignant pleural mesothelioma. Methods: From 1980 to 1997, 183 patients underwent extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy. Results: Forty-three women and 140 men (age range 31-76 years) had a median follow-up of 13 months. The perioperative mortality rate was 3.8 % (7 deaths) and the morbidity, 50%. Survival in the 176 remaining patients was 38% at 2 years and 15% at 5 years (median 19 months). Univariate analysis identified 3 prognostic variables associated with improved survival: epithelial cell type (52% 2-year survival, 21% 5-year survival, 26-month median survival; P =.0001), negative resection margins (44% at 2 years, 25% at 5 years, median 23 months; P =.02), and extrapleural nodes without metastases (42% at 2 years, 17% at 5 years, median 21 months; P =.004). Using the Cox proportional hazards, the relative risk of death was calculated for nonepithelial cell type (OR 3.0, CI 2.0-4.5; P < .0001), positive resection margins (OR 1.7, CI 1.2-2.6; P =.0082), and metastatic extrapleural nodes (OR 2.0, CI 1.3-3.2;P =.0026). Thirty-one patients with 3 positive variables had the best survival (68% 2-year survival, 46% 5-year survival, median 51 months; P =.013). A previously published staging system using these variables stratified survival (P <.05). Conclusions: (1) Multimodality therapy including extrapleural pneumonectomy is feasible in selected patients with malignant pleural mesotheliomas, (2) pre-resectional evaluation of extrapleural nodes may select patients for radical therapy, (3) microscopic resection margins affect long-term survival, highlighting the need for further investigation of locoregional control, and (4) patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival. |
| Document Type: Proceedings Paper |
| Language: English |
| Reprint Address: Sugarbaker, DJ (reprint author), Brigham & Womens Hosp, Div Thorac Surg, 75 Francis St, Boston, MA 02115 USA |
Addresses:
1. Brigham & Womens Hosp, Div Thorac Surg, Boston, MA 02115 USA
2. Brigham & Womens Hosp, Dept Pathol, Boston, MA 02115 USA
3. Harvard Univ, Sch Med, Dana Farber Canc Inst, Surg Serv, Boston, MA 02115 USA
4. Harvard Univ, Sch Med, Dana Farber Canc Inst, Dept Adult Oncol, Boston, MA 02115 USA
5. Univ Massachusetts, Worcester, MA 01605 USA |
| Publisher: MOSBY-YEAR BOOK INC, 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA |
| Subject Category: Cardiac & Cardiovascular Systems; Respiratory System; Surgery |
| IDS Number: 154PU |
| ISSN: 0022-5223 |
|
| | | | | | | | | Record from Web of Science® | | | | | | | | | |