Infante Maurizio, Morenghi Emanuela, Bottoni Edoardo, Zucali Paolo, Rahal Daoud, Morlacchi Andrea, Ascolese Anna Maria, De Rose Fiorenza, Navarria Pierina, Crepaldi Alessandro, Testori Alberto, Voulaz Emanuele, Errico Valentina, Perrino Matteo, Scorsetti Marta, Chiti Arturo, Santoro Armando, Alloisio Marco
Department of Thoracic Surgery, University Hospital Borgo Trento, Verona, Italy
Clinical Research Unit, Humanitas Research Hospital, Rozzano (Milan), Italy.
Eur J Cardiothorac Surg. 2016 Dec;50(6):1077-1082. doi: 10.1093/ejcts/ezw215. Epub 2016 Jun 21.
We examined a series of malignant pleural mesothelioma (MPM) patients who underwent radical surgery to explore relationships among comorbidity, postoperative morbidity and survival.
A retrospective analysis was carried out of all MPM patients operated on in a single centre from 2000 to 2015. The Charlson Comorbidity Index (CCI) was used to classify patients according to their underlying condition. Postoperative complications were scored according to WHO-derived criteria. Survival comparisons were performed by Cox analysis.
Ninety-one patients underwent extrapleural pneumonectomy (EPP), 47 underwent pleurectomy decortication (PD) and 25 underwent palliative pleurectomy. The mean CCI of PD patients was significantly higher compared with that of EPP patients (P= 0.044). The frequency of grade 3+ complications was similar between EPP and PD (27 vs 26%). However, EPP patients had a 6-fold higher frequency of pleural sepsis (24 vs 4%, P= 0.002) occurring up to 695 days postoperatively. Median overall survival was 19 months (95% CI 13-25) after EPP, 30 months (95% CI 20-35) after PD and 13 months (95% CI 5-32) after palliative pleurectomy. At multivariate analysis, CCI (P< 0.001), histology (P= 0.014) and pleural sepsis (P= 0.001), but not complete resection, were significantly associated with survival. There was a trend in favour of PD over palliative resection after adjusting for histology and CCI.
The CCI is an independent predictor of survival in MPM patients undergoing radical surgery. Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP. Surgical treatment of MPM remains debatable.
我们研究了一系列接受根治性手术的恶性胸膜间皮瘤（MPM）患者，以探讨合并症、术后发病率和生存率之间的关系。
对2000年至2015年在单一中心接受手术的所有MPM患者进行回顾性分析。采用Charlson合并症指数（CCI）根据患者的基础疾病对其进行分类。术后并发症根据世界卫生组织制定的标准进行评分。通过Cox分析进行生存比较。
91例患者接受了胸膜外全肺切除术（EPP），47例接受了胸膜剥脱术（PD），25例接受了姑息性胸膜切除术。PD患者的平均CCI显著高于EPP患者（P = 0.044）。EPP和PD患者3级及以上并发症的发生率相似（分别为27%和26%）。然而，EPP患者术后长达695天发生胸膜脓毒症的频率高出6倍（分别为24%和4%，P = 0.002）。EPP术后的中位总生存期为19个月（95%置信区间为第13 - 25个月），PD术后为30个月（95%置信区间为第20 - 35个月），姑息性胸膜切除术后为13个月（95%置信区间为第5 - 32个月）。在多变量分析中，CCI（P < 0.001）、组织学类型（P = 0.014）和胸膜脓毒症（P = 0.001），而非完全切除，与生存率显著相关。在调整组织学类型和CCI后，有证据表明PD优于姑息性切除术。
CCI是接受根治性手术的MPM患者生存的独立预测因素。由于胸膜脓毒症的发生率较高且具有不良影响，它可能导致EPP后预期寿命缩短。MPM的手术治疗仍存在争议。
