Division of Thoracic Surgery, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
Dept of Medical Imaging, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Eur Respir J. 2017 Mar 15;49(3). doi: 10.1183/13993003.01428-2016. Print 2017 Mar.
Tumour thickness was assessed to determine if this parameter could refine patients' selection for multimodality therapy in malignant pleural mesothelioma.We reviewed 65 consecutive treatment-naïve malignant pleural mesothelioma patients undergoing surgery for mesothelioma after radiation therapy (SMART). Total tumour thickness was determined by measuring the maximal thickness on nine predefined sectors on the chest wall, mediastinum and diaphragm.After a median follow-up of 19 months, 40 patients (62%) developed recurrence and 36 died (55%). Total tumour thickness, ranging between 2.4 and 21 cm (median 6.9 cm), correlated with tumour volume (p<0.0001, R=0.29) and maximum standardised uptake value (p=0.006, R=0.11). Total tumour thickness had a significant impact on overall survival and disease-free survival in univariate analysis. In multivariate analysis, total tumour thickness remained an independent predictor of survival (p=0.02, hazard ratio (HR) 1.12, 95% CI 1.02-1.23) and disease-free survival (p=0.01, HR 1.13, 95% CI 1.03-1.24) along with epithelial histologic subtype (p<0.0001, HR 0.25, 95% CI 0.13-0.50) and pN2 disease (p=0.03, HR 2.15, 95% CI 1.07-4.33). Diaphragmatic tumour thickness correlated best with time to recurrence (p=0.002, R=0.22) and time to death (p=0.003, R=0.2).The impact of tumour thickness on survival and disease-free survival independent of histologic subtypes and nodal disease is extremely encouraging. This parameter could potentially be used to refine the clinical staging of malignant pleural mesothelioma and optimise patient selection for radical treatment.
肿瘤厚度评估以确定这一参数是否可以细化恶性胸膜间皮瘤患者的多模式治疗选择。我们回顾了 65 例连续接受放射治疗后手术治疗恶性胸膜间皮瘤的初治恶性胸膜间皮瘤患者（SMART）。通过测量胸壁、纵隔和膈肌上 9 个预定部位的最大厚度来确定总肿瘤厚度。中位随访 19 个月后，40 例（62%）患者复发，36 例患者死亡（55%）。肿瘤总厚度范围为 2.4 至 21cm（中位数 6.9cm），与肿瘤体积相关（p<0.0001，R=0.29）和最大标准化摄取值相关（p=0.006，R=0.11）。肿瘤总厚度在单因素分析中对总生存和无病生存有显著影响。多因素分析显示，肿瘤总厚度仍是生存（p=0.02，风险比（HR）1.12，95%置信区间 1.02-1.23）和无病生存（p=0.01，HR 1.13，95%置信区间 1.03-1.24）的独立预测因素，同时也是上皮组织学亚型（p<0.0001，HR 0.25，95%置信区间 0.13-0.50）和 pN2 疾病（p=0.03，HR 2.15，95%置信区间 1.07-4.33）的独立预测因素。膈肌肿瘤厚度与复发时间（p=0.002，R=0.22）和死亡时间（p=0.003，R=0.2）相关性最佳。肿瘤厚度对生存和无病生存的影响独立于组织学亚型和淋巴结疾病，这令人极为鼓舞。这一参数可能有助于细化恶性胸膜间皮瘤的临床分期，并优化根治性治疗患者的选择。
