恶性胸膜间皮瘤术后长期生存的预后评分：一项多中心分析

Prognostic Score of Long-Term Survival After Surgery for Malignant Pleural Mesothelioma: A Multicenter Analysis.

作者信息

Leuzzi Giovanni, Rea Federico, Spaggiari Lorenzo, Marulli Giuseppe, Sperduti Isabella, Alessandrini Gabriele, Casiraghi Monica, Bovolato Pietro, Pariscenti Gianluca, Alloisio Marco, Infante Maurizio, Pagan Vittore, Fontana Paolo, Oliaro Alberto, Ruffini Enrico, Ratto Giovanni Battista, Leoncini Giacomo, Sacco Rocco, Mucilli Felice, Facciolo Francesco

机构信息

Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy.

Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.

出版信息

Ann Thorac Surg. 2015 Sep;100(3):890-7. doi: 10.1016/j.athoracsur.2015.04.087. Epub 2015 Jul 9.

DOI:10.1016/j.athoracsur.2015.04.087

PMID:26163973

Abstract

BACKGROUND

Despite ongoing efforts to improve therapy in malignant pleural mesothelioma, few patients undergoing extrapleural pneumonectomy experience long-term survival (LTS). This study aims to explore predictors of LTS after extrapleural pneumonectomy and to define a prognostic score.

METHODS

From January 2000 to December 2010, we retrospectively reviewed clinicopathologic and oncological factors in a multicenter cohort of 468 malignant pleural mesothelioma patients undergoing extrapleural pneumonectomy. LTS was defined as survival longer than 3 years. Associations were evaluated using χ(2), Student's t, and Mann-Whitney U tests. Logistic regression, Cox regression hazard model, and bootstrap analysis were applied to identify outcome predictors. Survival curves were calculated by the Kaplan-Meier method. Receiver operating characteristic analyses were used to estimate optimal cutoff and area under the curve for accuracy of the model.

RESULTS

Overall, 107 patients (22.9%) survived at least 3 years. Median overall, cancer-specific, and disease-free survival times were 60 (95% confidence interval [CI], 51 to 69), 63 (95% CI, 54 to 72), and 49 months (95% CI, 39 to 58), respectively. At multivariate analysis, age (odds ratio, 0.51; 95% CI, 0.31 to 0.82), epithelioid histology (odds ratio, 7.07; 95% CI, 1.56 to 31.93), no history of asbestos exposure (odds ratio, 3.13; 95% CI, 1.13 to 8.66), and the ratio between metastatic and resected lymph nodes less than 22% (odds ratio, 4.12; 95% CI, 1.68 to 10.12) were independent predictors of LTS. According to these factors, we created a scoring system for LTS that allowed us to correctly predict overall, cancer-specific, and disease-free survival in the total sample, obtaining two different groups with favorable or poor prognosis (area under the curve, 0.74; standard error, 0.04; p < 0.0001).

CONCLUSIONS

Our prognostic model facilitates the prediction of LTS after surgery for malignant pleural mesothelioma and can help to stratify the outcome and, eventually, tailor postoperative treatment.

摘要

背景

尽管一直在努力改善恶性胸膜间皮瘤的治疗方法，但接受胸膜外全肺切除术的患者中，很少有人能获得长期生存（LTS）。本研究旨在探讨胸膜外全肺切除术后长期生存的预测因素，并确定一个预后评分系统。

方法

回顾性分析2000年1月至2010年12月间468例行胸膜外全肺切除术的恶性胸膜间皮瘤患者的多中心队列的临床病理和肿瘤学因素。长期生存定义为生存超过3年。采用χ²检验、学生t检验和曼-惠特尼U检验评估相关性。应用逻辑回归、Cox回归风险模型和自助法分析来确定预后预测因素。采用Kaplan-Meier法计算生存曲线。通过受试者工作特征分析来估计模型准确性的最佳截断值和曲线下面积。

结果

总体而言，107例患者（22.9%）存活至少3年。总体、癌症特异性和无病生存时间的中位数分别为60个月（95%置信区间[CI]，51至69）、63个月（95%CI，54至72）和49个月（95%CI，39至58）。多因素分析显示，年龄（比值比，0.51；95%CI，0.31至0.82）、上皮样组织学类型（比值比，7.07；95%CI，1.56至31.93）、无石棉接触史（比值比，3.13；95%CI，1.13至8.66）以及转移淋巴结与切除淋巴结的比例小于22%（比值比，4.12；95%CI，1.68至10.12）是长期生存的独立预测因素。根据这些因素，我们创建了一个长期生存评分系统，该系统能够正确预测总样本中的总体、癌症特异性和无病生存情况，从而得到预后良好或不良的两个不同组（曲线下面积，0.74；标准误，0.04；p<0.0001）。