Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany. Servet
Lung Cancer. 2011 Jan;71(1):75-81. doi: 10.1016/j.lungcan.2009.08.019. Epub 2009 Sep 17.
The role of surgery in the management of malignant pleural mesothelioma (MPM) is controversial and there are no established guidelines. We describe the feasibility and long-term outcomes associated with Radical Pleurectomy (RP) as surgical therapy modality in a standardized trimodality therapy concept of MPM.
From November 2002 to October 2007, 35 out of 102 consecutive patients with MPM were enrolled in our prospective database. They underwent trimodality therapy, including RP followed by 4 cycles of chemotherapy with Cisplatin (75 mg/m(2))/Pemetrexed (500 mg/m(2)) and radiotherapy 4-6 weeks after operation.
Median age was 65 years. Nineteen patients were in advanced stages III and IV (54.3%). Tumor histology was epithelial in 27 patients (77.1%). Macroscopic complete resection could be achieved in 18 patients (51.4%). Surgical morbidity/mortality and trimodality treatment-related mortality were 20.0%, 2.9% and 5.8%, respectively. Thirty-three patients completed the trimodality therapy. Median follow-up was 21.7 months. Overall median survival was 30.0 months. One-, 2-, and 3-year-survival were 69%, 50% and 31%, respectively. Advanced stages III/IV (p=0.06), macroscopic incomplete resections (p=0.001), non-epithelial histology (p=0.55) and nodal metastases (p=0.19) were associated with poorer survival.
The trimodality therapy concept with RP demonstrates promising results in terms of long-term survival, morbidity and mortality. We propose that a surgical philosophy of limiting the procedure related morbidity while achieving comparable cytoreductive results allows patients to maintain physiological reserve to be eligible for multimodality treatment options in the long-term. The observed and theoretical benefits of this trimodality treatment approach warrant confirmation in larger RCT.
手术在恶性胸膜间皮瘤（MPM）治疗中的作用存在争议，目前尚无既定的指南。我们描述了根治性胸膜切除术（RP）作为一种手术治疗方式，在 MPM 的标准化三联疗法概念中的可行性和长期结果。
从 2002 年 11 月到 2007 年 10 月，102 例连续患者中有 35 例被纳入我们的前瞻性数据库。他们接受了三联疗法，包括 RP 后 4 个周期顺铂（75mg/m2）/培美曲塞（500mg/m2）化疗和术后 4-6 周放疗。
中位年龄为 65 岁。19 例患者处于晚期 III 期和 IV 期（54.3%）。27 例患者的肿瘤组织学为上皮型（77.1%）。18 例患者实现了大体完全切除（51.4%）。手术发病率/死亡率和三联疗法相关死亡率分别为 20.0%、2.9%和 5.8%。33 例患者完成了三联疗法。中位随访时间为 21.7 个月。总中位生存期为 30.0 个月。1、2 和 3 年生存率分别为 69%、50%和 31%。晚期 III/IV 期（p=0.06）、大体不完全切除（p=0.001）、非上皮组织学（p=0.55）和淋巴结转移（p=0.19）与较差的生存相关。
RP 三联疗法在长期生存、发病率和死亡率方面显示出有希望的结果。我们提出，一种手术理念，即在限制与手术相关的发病率的同时实现相当的减瘤效果，可以使患者保持生理储备，有资格在长期内接受多模式治疗选择。这种三联疗法治疗方法的观察到的和理论上的益处需要在更大的 RCT 中得到证实。
