Vigneswaran Wickii T, Kircheva Diana Y, Ananthanarayanan Vijayalakshimi, Watson Sydeaka, Arif Qudsia, Celauro Amy Durkin, Kindler Hedy L, Husain Aliya N
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
Ann Thorac Surg. 2017 Mar;103(3):962-966. doi: 10.1016/j.athoracsur.2016.08.063. Epub 2016 Oct 17.
Macroscopic complete surgical resection with adjuvant chemotherapy can provide a survival advantage in patients with malignant pleural mesothelioma (MPM). Patients with nonepithelioid histology are largely excluded from such radical operations even though they might benefit. The degree of epithelioid differentiation varies in biphasic histology. We report the outcomes of pleurectomy and decortication and the effect of epithelioid differentiation on overall survival of patients with MPM.
This report is based on the outcomes of 144 patients who underwent pleurectomy and decortication at a single institution between 2008 and 2015. The variables assessed were age, gender, histology, and pathologic T and N stage. No patients with pure sarcomatoid histology were included. Two independent pathologists estimated the percentage of epithelioid histology. A Cox regression model was used to identify significant predictors of survival. The Kaplan-Meier method was used to summarize overall and subgroup survival.
Included were 116 men and 28 women with a median age of 69 years (range, 43 to 88 years). The 2-year survival from pleurectomy and decortication was 20%. Median survival overall was 13.34 months and was 20.1 months for the 100% epithelioid subgroup (n = 77), 11.8 months for the 51% to 99% epithelioid subgroup (n = 39), and 6.62 months for the less than 50% epithelioid subgroup (n = 28). The amount of epithelioid differentiation was a significant predictor of survival (p < 0.001). Differences in survival based on the T, but N stage, were not statistically significant.
The percentage of epithelioid differentiation is an independent predictor of survival in MPM and should be taken into careful consideration when recommending surgical treatment for patients with biphasic MPM.
对于恶性胸膜间皮瘤（MPM）患者，宏观上的完全手术切除联合辅助化疗可带来生存优势。非上皮样组织学类型的患者即使可能从中获益，也大多被排除在这类根治性手术之外。在双相组织学中，上皮样分化程度各不相同。我们报告了胸膜切除术和剥脱术的结果以及上皮样分化对MPM患者总生存的影响。
本报告基于2008年至2015年在单一机构接受胸膜切除术和剥脱术的144例患者的结果。评估的变量包括年龄、性别、组织学类型以及病理T和N分期。未纳入纯肉瘤样组织学类型的患者。两名独立病理学家评估上皮样组织学的百分比。采用Cox回归模型确定生存的显著预测因素。采用Kaplan-Meier方法总结总生存和亚组生存情况。
纳入患者116例男性和28例女性，中位年龄69岁（范围43至88岁）。胸膜切除术和剥脱术后2年生存率为20%。总体中位生存时间为13.34个月，100%上皮样亚组（n = 77）为20.1个月，51%至99%上皮样亚组（n = 39）为11.8个月，上皮样小于50%亚组（n = 28）为6.62个月。上皮样分化程度是生存的显著预测因素（p < 0.001）。基于T分期但非N分期的生存差异无统计学意义。
上皮样分化百分比是MPM患者生存的独立预测因素，在为双相MPM患者推荐手术治疗时应仔细考虑。
