Thoracic Surgery Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
Lung Cancer. 2012 Jul;77(1):151-5. doi: 10.1016/j.lungcan.2011.12.009. Epub 2012 Jan 11.
The effects on long-term post-operative quality of life (QoL) and disease-control in malignant pleural mesothelioma (MPM) of extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are compared. Seventy-seven patients affected by early-stage MPM received EPP (40) or P/D (37) associated with multimodal treatment between 1998 and 2009 at our institution. The last consecutive 39 (19 EPP and 20 P/D) were asked to answer the EORTC-QLQ-C30 questionnaire at baseline and at 6- and 12-months after treatment completion to evaluate the impact on QoL of both procedures. QoL evaluation was stopped at recurrence demonstration. Twenty-five (62%) EPP vs 9 (24%) P/D patients (p = 0.002) had in-hospital major complications, and 2/40 (5%) EPP vs no one P/D patients died after surgery. Both procedures caused a significant impairment of all the considered variables of the EORTC-QLQ-C30 questionnaire after treatment completion; only P/D patients returned at baseline levels after 12 months. EPP patients had a worse long-term post-operative QoL when compared with P/D. Median post-operative disease-free period was longer for EPP patients (14 vs 11 months) whereas the residual life to death period after recurrence detection was significantly longer for P/D patients (13 vs 9 months) (p = 0.01). Median long-term survival was longer, even not significant, for P/D patients (25 vs 20 months). MPM patients submitted to EPP had a higher post-operative complication rate, a worse long-term QoL, a shorter residual life time after recurrent disease, despite a similar long-term survival when compared to P/D.
比较了胸膜外全肺切除术（EPP）和胸膜切除术/剥脱术（P/D）对恶性胸膜间皮瘤（MPM）患者术后长期生活质量（QoL）和疾病控制的影响。1998 年至 2009 年期间，我们机构对 77 例早期 MPM 患者进行了 EPP（40 例）或 P/D（37 例）治疗，并联合了多模式治疗。最后连续 39 例（19 例 EPP 和 20 例 P/D）在基线和治疗完成后 6 个月和 12 个月时被要求回答 EORTC-QLQ-C30 问卷，以评估两种手术对 QoL 的影响。在出现复发的情况下，QoL 评估停止。25 例（62%）EPP 患者与 9 例（24%）P/D 患者（p=0.002）发生院内重大并发症，40 例 EPP 患者中有 2 例（5%）与无 P/D 患者术后死亡。两种手术在治疗完成后都会显著损害 EORTC-QLQ-C30 问卷中所有考虑的变量；只有 P/D 患者在 12 个月后恢复到基线水平。与 P/D 相比，EPP 患者的术后长期 QoL 更差。EPP 患者的无病生存期较长（14 个月 vs 11 个月），而在复发检测后死亡的剩余生存时间 P/D 患者明显更长（13 个月 vs 9 个月）（p=0.01）。即使没有统计学意义，P/D 患者的中位长期生存率也更长（25 个月 vs 20 个月）。与 P/D 相比，接受 EPP 的 MPM 患者术后并发症发生率更高，长期 QoL 更差，复发性疾病后剩余生存时间更短，但长期生存率相似。
