Kostron Arthur, Friess Martina, Inci Ilhan, Hillinger Sven, Schneiter Didier, Gelpke Hans, Stahel Rolf, Seifert Burkhardt, Weder Walter, Opitz Isabelle
Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Oncology, University Hospital Zurich, Zurich, Switzerland.
Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):740-746. doi: 10.1093/icvts/ivw422.
The objective of this retrospective study was to assess perioperative outcomes, overall survival and freedom from recurrence after induction chemotherapy followed by extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) in patients with mesothelioma in a propensity score matched analysis.
Between September 1999 and August 2015, 167 patients received multimodality treatment (platinum-based chemotherapy followed by EPP [ n = 141] or P/D [ n = 26]). We performed 2:1 propensity score matching for gender, laterality, epithelioid histological subtype and International Mesothelioma Interest Group (iMig) stage (52 EPP and 26 P/D).
Postoperative major morbidity (48% vs 58%, P = 0.5) was similar in both groups; however, the complication profile and severity were different and favoured P/D; the 90-day mortality (8% vs 0%, P = 0.3) rate was lower in P/D although not statistically significant. Prolonged air leak (≥10 days) occurred in 15 patients (58%) undergoing P/D. The intensive care unit stay was significantly longer after EPP ( P = 0.001). Freedom from recurrence was similar for both groups (EPP: median 15 months, 95% confidence interval [CI]: 10-21; P/D: 13 months, 95% CI: 11-17) ( P = 0.2). Overall survival was significantly longer for patients undergoing P/D (median 32 months, 95% CI: 29-35) compared to EPP (23 months, 95% CI: 21-25) ( P = 0.031), but in the P/D group many cases were censored (73%) and the follow-up time was relatively short.
P/D and EPP seem to have similar rates of major morbidity, although the profile of complications is different and more severe after EPP. Freedom from recurrence is comparable in both groups whereas improved overall survival needs to be confirmed in a large patient group with longer follow-up.
本回顾性研究的目的是在倾向评分匹配分析中，评估接受诱导化疗后行胸膜外肺切除术（EPP）或胸膜剥脱术/纤维板剥脱术（P/D）的间皮瘤患者的围手术期结局、总生存期和无复发生存期。
1999年9月至2015年8月期间，167例患者接受了多模式治疗（铂类化疗后行EPP [n = 141]或P/D [n = 26]）。我们对性别、左右侧、上皮样组织学亚型和国际间皮瘤兴趣小组（iMig）分期进行了2:1倾向评分匹配（52例EPP和26例P/D）。
两组术后主要发病率相似（48%对58%，P = 0.5）；然而，并发症的类型和严重程度不同，P/D更具优势；P/D组的90天死亡率（8%对0%，P = 0.3）较低，尽管无统计学意义。15例（58%）接受P/D的患者发生了持续性漏气（≥10天）。EPP后重症监护病房住院时间明显更长（P = 0.001）。两组的无复发生存期相似（EPP：中位15个月，95%置信区间[CI]：10 - 21；P/D：13个月，95% CI：11 - 17）（P = 0.2）。与EPP（23个月，95% CI：21 - 25）相比，接受P/D的患者总生存期明显更长（中位32个月，95% CI：29 - 35）（P = 0.031），但P/D组许多病例被截尾（73%）且随访时间相对较短。
P/D和EPP的主要发病率似乎相似，尽管并发症类型不同，且EPP后更严重。两组的无复发生存期相当，而总生存期的改善需要在更大的患者群体中进行更长时间的随访来证实。
