*Division of Thoracic Surgery, †Department of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡Department of Biostatistics, Epidemiology, Biostatistics and Prevention Unit, University Zurich, Zurich, Switzerland; §Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria; and ‖Laboratory of Molecular Oncology, University Hospital Zurich, Zurich, Switzerland.
J Thorac Oncol. 2015 Nov;10(11):1634-41. doi: 10.1097/JTO.0000000000000661.
Treatment of malignant pleural mesothelioma (MPM) remains a clinical challenge. The aim of this study was to identify selection factors for allocation of MPM patients to multimodal therapy based on survival data from 12 years of experience.
Eligible patients had MPM of all histological subtypes with clinical stage T1-3 N0-2 M0. Induction chemotherapy consisted of cisplatin/gemcitabine (cis/gem) or cisplatin/pemetrexed (cis/pem), followed by extrapleural pneumonectomy (EPP). Multivariate analysis was performed to assess independent prognosticators for overall survival (OS). A Multimodality Prognostic Score was developed based on clinical variables available before surgery.
From May 1999 to August 2011, 186 MPM patients were intended to be treated with induction chemotherapy followed by EPP. Hematologic toxicity was significantly less frequent after cis/pem compared to cis/gem, but there was no difference in response or OS between the regimens. One hundred and twenty-eight patients underwent EPP with a 30-day mortality of 4.7%. Fifty-two percent of the patients received adjuvant radiotherapy. The median OS of patients undergoing EPP was significantly longer with 22 months (95% confidence interval: 20-24) when compared to 11 months (9-12) for patients treated without EPP. A prognostic score was defined considering tumor volume, histology, C-reactive protein level, and response to chemotherapy that identified patient groups not benefitting from multimodality treatment which was confirmed in an independent cohort.
Patients receiving induction chemotherapy followed by EPP for MPM of all histological subtypes and irrespective of nodal status showed a median survival of 22 months. A prognostic score is proposed to help patient allocation for surgery after validation in an independent cohort.
恶性胸膜间皮瘤（MPM）的治疗仍然是一个临床挑战。本研究的目的是根据 12 年的经验，从生存数据中确定将 MPM 患者分配给多模式治疗的选择因素。
合格的患者为所有组织学亚型的 MPM 患者，临床分期为 T1-3 N0-2 M0。诱导化疗包括顺铂/吉西他滨（cis/gem）或顺铂/培美曲塞（cis/pem），随后进行胸膜外全肺切除术（EPP）。进行多变量分析以评估总生存（OS）的独立预后因素。根据手术前可用的临床变量开发了多模式预后评分。
从 1999 年 5 月至 2011 年 8 月，计划有 186 名 MPM 患者接受诱导化疗，随后进行 EPP。与 cis/gem 相比，cis/pem 的血液学毒性明显减少，但两种方案的反应和 OS 无差异。128 名患者接受了 EPP，30 天死亡率为 4.7%。52%的患者接受了辅助放疗。与未接受 EPP 治疗的患者相比，接受 EPP 的患者的中位 OS 明显更长，为 22 个月（95%置信区间：20-24），而未接受 EPP 治疗的患者为 11 个月（9-12）。考虑到肿瘤体积、组织学、C 反应蛋白水平和对化疗的反应，定义了一个预后评分，该评分确定了不能从多模式治疗中获益的患者群体，这在一个独立的队列中得到了证实。
所有组织学亚型和不论淋巴结状态的 MPM 患者接受诱导化疗后行 EPP 治疗，中位生存时间为 22 个月。提出了一个预后评分，以帮助在独立队列中验证后为手术分配患者。
